Healthcare Provider Details

I. General information

NPI: 1134468820
Provider Name (Legal Business Name): COURTNEY CARABAJAL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 SIPAPU ST BOX 6952
TAOS NM
87571-6489
US

IV. Provider business mailing address

413 SIPAPU ST BOX 6952
TAOS NM
87571-6489
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-5857
  • Fax: 575-758-5860
Mailing address:
  • Phone: 575-758-5857
  • Fax: 575-758-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-56791
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: