Organization
SALLY SMITH NP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SALLY ANNE SMITH FNP (NURSE PRACTITIONER)
(505) 570-7858
Entity
Organization
Contact information
Practice address
1640 OLD PECOS TRL STE E&F, SANTA FE, NM 87505-4776
(505) 310-6974
(855) 795-1933
Mailing address
96 LOS ALTOS DE CICUYE, PECOS, NM 87552-2555
(505) 310-6974
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861981193
—
NM
Enumeration date
12/19/2020
Last updated
12/19/2020
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