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General NPI Number Information
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NPI Number | 1083293104
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Entity Type | Individual
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Provider Name | PATRICIA L LANDRETH FNP
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Gender | Female
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 2402 W PIERCE ST STE 2A
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City | CARLSBAD
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State | NM
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Zip | 88220-3568
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Country | US
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Telephone | 575-887-0637
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Fax | 575-887-0638
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Provider Business Mailing Address
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Address Line | 2402 W PIERCE ST STE 2A
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City | CARLSBAD
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State | NM
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Zip | 88220-3568
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Country | US
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Telephone | 575-887-0637
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Fax | 575-887-0638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 63661
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F03211422
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License Number State | NM
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