=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265965362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIA NICOLE SAENZ DNP, FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2017
-----------------------------------------------------
Last Update Date | 09/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2435 S TELSHOR BLVD
-----------------------------------------------------
City | LAS CRUCES
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88011-5029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 755-227-7985
-----------------------------------------------------
Fax | 575-522-3416
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 LOS MOROS DR
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79932-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-202-2820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | CNP-03200
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------