Healthcare Provider Details

I. General information

NPI: 1598863342
Provider Name (Legal Business Name): ANNIE RAFTER CNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/16/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ROSINA ST SUITE E
SANTA FE NM
87505
US

IV. Provider business mailing address

1925 ROSINA ST SUITE E
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-8262
  • Fax: 505-984-1312
Mailing address:
  • Phone: 505-984-8262
  • Fax: 505-984-1312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR29765
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR29765
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCNP00587
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: