Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | APN0000018106 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP-02392 | NM |
NPI | 1003238353 |
---|---|
Provider Name | Ms. Misti Lynn |
First Address | Las Cruces, NM 88011-7043 |
Second Address | Las Cruces, NM 88011-7043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 20/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
345387YUD3 | (02) | NM |