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General NPI Number Information
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NPI Number | 1538775382
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Entity Type | Individual
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Provider Name | ANNA NANCE APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1300 ENTERPRISE RD
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City | SOCORRO
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State | NM
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Zip | 87801-4199
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Country | US
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Telephone | 575-835-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 ENTERPRISE RD
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City | SOCORRO
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State | NM
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Zip | 87801-4199
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 74671
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 62624
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License Number State | NM
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