MEDICARE: CHRISTINE MARIE PADILLA FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	76704	NM

General Provider Information

NPI Number	:	1245084110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE MARIE PADILLA FNP-C

Provider Business Mailing Address
First Line	:	1916 MONTEZUMA ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3633
Country	:	US
Telephone Number	:	505-617-1112
Fax Number	:	505-454-2497

Provider Business Practice Location Address
First Line	:	1916 MONTEZUMA ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3633
Country	:	US
Telephone Number	:	505-617-1112
Fax Number	:	505-454-2497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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