Individual
ANNETTE RANDLEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2300 E 30TH ST, BLDG B, SUITE 102, FARMINGTON, NM 87401-8990
(505) 324-1000
(505) 324-1199
Mailing address
2017 SIERRA AVE, AZTEC, NM 87410-1540
(505) 334-6896
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R25038
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002777
LOVELACE SALUD
NM
01
—
201016092
PRESBYTERIAN
NM
01
—
32D0943693
CLIA
—
01
—
400521029
EMC
NM
01
—
850462631
STATE ID
NM
01
—
NM006F13
BLUE CROSS
NM
05
—
S3309
—
NM
Enumeration date
07/14/2006
Last updated
01/22/2008
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