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General NPI Number Information
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NPI Number | 1548917396
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Entity Type | Individual
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Provider Name | JANEL OUTLAW APRN
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Gender | Female
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 4391 E LOHMAN AVE
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City | LAS CRUCES
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State | NM
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Zip | 88011-8255
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Country | US
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Telephone | 575-522-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 4543 ALAMO CANYON CIR
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City | LAS CRUCES
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State | NM
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Zip | 88012-5125
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Country | US
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Telephone | 662-889-8149
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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 | 53240
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License Number State | NM
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