Healthcare Provider Details

I. General information

NPI: 1295078335
Provider Name (Legal Business Name): FUNMILAYO AINA DNP, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FUNMILAYO CROWELL RN

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RODEO RD SUITE C-14
SANTA FE NM
87507
US

IV. Provider business mailing address

2801 RODEO RD SUITE C-14
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-3514
  • Fax: 866-354-3833
Mailing address:
  • Phone: 505-303-3514
  • Fax: 866-354-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55817
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number55817
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: