Healthcare Provider Details

I. General information

NPI: 1861429375
Provider Name (Legal Business Name): NAOMI LANDAU CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WHS 901 W.ALAMEDA STREET SUITE 25
SANTA FE NM
87501-1673
US

IV. Provider business mailing address

WHS 901 W.ALAMEDA STREET
SANTA FE NM
87501-1673
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-9421
  • Fax: 505-982-7321
Mailing address:
  • Phone: 505-955-9421
  • Fax: 505-982-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR19367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: