Healthcare Provider Details

I. General information

NPI: 1861323354
Provider Name (Legal Business Name): ASHLEY DIANE MARKUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 CAMINO SAN ACACIO UNIT C
SANTA FE NM
87505-5904
US

IV. Provider business mailing address

1047 CAMINO SAN ACACIO UNIT C
SANTA FE NM
87505-5904
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-4636
  • Fax:
Mailing address:
  • Phone: 505-577-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR67561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: