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General NPI Number Information
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NPI Number | 1164249413
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Entity Type | Individual
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Provider Name | JENNIFER SHERISE PALLANTE CNP
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 4588 PARADISE BLVD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4105
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Country | US
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Telephone | 505-998-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 3212 20TH AVE SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-1662
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Country | US
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Telephone | 505-220-9798
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 78804
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License Number State | NM
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