Individual
MR. ILANGO DHARMARAJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP-BC
Contact information
Practice address
465 SAINT MICHAELS DR STE 116, SANTA FE, NM 87505-7621
(505) 984-2600
Mailing address
465 SAINT MICHAELS DR STE 230, SANTA FE, NM 87505-8602
(505) 913-4710
(505) 913-4711
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
55465
NM
363LG0600X
Gerontology Nurse Practitioner
55465
NM
Other
Enumeration date
03/11/2019
Last updated
09/24/2022
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