Healthcare Provider Details

I. General information

NPI: 1336322064
Provider Name (Legal Business Name): SAUNDRA K MCKENNA CNM, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST STE B1
SANTA FE NM
87505-2157
US

IV. Provider business mailing address

2074 GALISTEO ST STE B1
SANTA FE NM
87505-2157
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-6566
  • Fax:
Mailing address:
  • Phone: 505-690-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCNM466
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: