Healthcare Provider Details

I. General information

NPI: 1215950449
Provider Name (Legal Business Name): MARIANN BREGIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 RODEO RD
SANTA FE NM
87507-4830
US

IV. Provider business mailing address

4001 RODEO RD
SANTA FE NM
87507-4830
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-8994
  • Fax: 505-473-1274
Mailing address:
  • Phone: 505-471-8994
  • Fax: 505-473-1274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR36389
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: