Healthcare Provider Details

I. General information

NPI: 1033032404
Provider Name (Legal Business Name): STEPHANIE APPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BUTTERFLY RD
TAOS NM
87571
US

IV. Provider business mailing address

PO BOX 1622
RANCHOS DE TAOS NM
87557-1622
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-0964
  • Fax:
Mailing address:
  • Phone: 575-613-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2126
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: