Healthcare Provider Details

I. General information

NPI: 1992694293
Provider Name (Legal Business Name): JOHANA WOLF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOHANA BENCOMO ZUBIATE RN

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

9 OLD CALLEJON RD
SANTA FE NM
87506-8742
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-5521
  • Fax:
Mailing address:
  • Phone: 505-629-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86106
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN-90591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: