Healthcare Provider Details

I. General information

NPI: 1992927347
Provider Name (Legal Business Name): DIANE LEE PAOLAZZI CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SAINT MICHAELS DR STE 104
SANTA FE NM
87505-7672
US

IV. Provider business mailing address

8020 CONSTITUTION PL NE STE 202
ALBUQUERQUE NM
87110-7640
US

V. Phone/Fax

Practice location:
  • Phone: 505-372-1052
  • Fax: 505-820-3172
Mailing address:
  • Phone: 505-998-3096
  • Fax: 505-998-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR17952
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: