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General NPI Number Information
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NPI Number | 1629417621
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Entity Type | Individual
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Provider Name | DAVITA ADANUVOR
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Gender | Female
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Dates
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Enumeration Date | 06/24/2013
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 807 CALLE CHAMISAL
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City | ESPANOLA
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State | NM
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Zip | 87532-2976
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Country | US
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Telephone | 505-372-4511
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Fax |
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Provider Business Mailing Address
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Address Line | 807 CALLE CHAMISAL
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City | ESPANOLA
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State | NM
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Zip | 87532-2976
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Country | US
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Telephone | 505-372-4511
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | CNP-02206
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61160839
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License Number State | WA
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