Healthcare Provider Details

I. General information

NPI: 1780080358
Provider Name (Legal Business Name): AUDRIANA APODACA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AIRPORT RD
SANTA TERESA NM
88008
US

IV. Provider business mailing address

385 CALLE DE ALEGRA BLDG. A
LAS CRUCES NM
88005-3423
US

V. Phone/Fax

Practice location:
  • Phone: 575-874-9338
  • Fax: 575-874-9359
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP126833
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-02940
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: