Healthcare Provider Details

I. General information

NPI: 1194677724
Provider Name (Legal Business Name): MARISELA ANN DALLMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/14/2026
Certification Date: 02/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 BECKNER RD STE 2650
SANTA FE NM
87507-3641
US

IV. Provider business mailing address

4801 BECKNER RD STE 2650
SANTA FE NM
87507-3641
US

V. Phone/Fax

Practice location:
  • Phone: 505-772-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number68201
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: