Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP-02304 | NM |
NPI | 1013331552 |
---|---|
Provider Name | Patricia A Drey |
First Address | Tijeras, NM 87059-8002 |
Second Address | Tijeras, NM 87059-8002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2014 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CNP-02304 | CNP LICENSE (01) | NM |