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General NPI Number Information
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NPI Number | 1952742173
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Entity Type | Organization
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Legal Business Name | MARY L. ESTES, CFNP, LLC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 106 BEULAH LANE
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City | RUIDOSO
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State | NM
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Zip | 88355-0009
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Country | US
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Telephone | 575-630-1055
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Fax | 575-630-1066
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Provider Business Mailing Address
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Address Line | PO BOX 9
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City | RUIDOSO
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State | NM
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Zip | 88355-0009
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Country | US
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Telephone | 575-630-1055
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Fax | 575-630-1066
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Authorized Official
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Title or Position | OWNER
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Name | MARY L. MOORE-ESTES
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Credential | FNP-C
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Telephone | 575-937-2516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CNP-02204
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License Number State | NM
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