Healthcare Provider Details

I. General information

NPI: 1518314855
Provider Name (Legal Business Name): SANDRA POPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 COMERCIANTES BLVD
SANTA TERESA NM
88008-9669
US

IV. Provider business mailing address

PO BOX 70
ANTHONY NM
88021-0070
US

V. Phone/Fax

Practice location:
  • Phone: 575-589-3438
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number540505
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: