MEDICARE: RACHELLE PINO NP

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	71711	NM

General Provider Information

NPI Number	:	1972209211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHELLE PINO NP

Provider Business Mailing Address
First Line	:	PO BOX 4744
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87502-4744
Country	:	US
Telephone Number	:	505-204-1920
Fax Number	:

Provider Business Practice Location Address
First Line	:	5501 HERRERA DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2684
Country	:	US
Telephone Number	:	505-913-3233
Fax Number	:

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

Provider Enumeration Date	:	02/07/2023
Last Update Date	:	02/07/2023

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