Healthcare Provider Details

I. General information

NPI: 1356559058
Provider Name (Legal Business Name): ANN WOOTEN LOWN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

3304 EL PASEO
SANTA FE NM
87501-6198
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-5913
  • Fax:
Mailing address:
  • Phone: 505-983-7996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR16615
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: