=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639255300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTJE POSTL RN, CFNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 08/31/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 CAMINO DE VIDA SUITE 300
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88435-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-472-4311
-----------------------------------------------------
Fax | 575-472-4313
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 CAMINO DE VIDA SUITE 300
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88435-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-472-4311
-----------------------------------------------------
Fax | 575-472-4313
-----------------------------------------------------
=====================================================
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 | R35159
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CNP00741
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------