=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023774783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LABERTA DEMPSEY CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2021
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 LLANO ST
-----------------------------------------------------
City | AZTEC
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87410-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-334-3404
-----------------------------------------------------
Fax | 505-334-3486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 844088
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75284-4088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-609-2258
-----------------------------------------------------
Fax | 505-609-2259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 64576
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------