Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 62076 | NM |
NPI | 1003400680 |
---|---|
Provider Name | Edna R Zapata |
First Address | Clovis, NM 88101-4092 |
Second Address | Clovis, NM 88101-4092 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2021 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20200132042 | ANCC (01) | NM |
62076 | APRN-CNP (01) | NM |