Healthcare Provider Details

I. General information

NPI: 1346892866
Provider Name (Legal Business Name): ELIZABETH OLIS AGNP-BC, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2019
Last Update Date: 05/11/2026
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE MEDICO STE 4
SANTA FE NM
87505-4761
US

IV. Provider business mailing address

6 CALLE MEDICO STE 4
SANTA FE NM
87505-4761
US

V. Phone/Fax

Practice location:
  • Phone: 505-498-0980
  • Fax: 505-395-9251
Mailing address:
  • Phone: 505-498-0980
  • Fax: 833-505-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60233
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number7202
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number67457
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number219309
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number7202
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number67457
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number67457
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: