Individual
MR. RUBEN ALFARO SUPAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
405 W COUNTRY CLUB RD, ROSWELL, NM 88201-5209
(505) 409-0831
Mailing address
PO BOX 8244, ROSWELL, NM 88202-8244
(575) 624-2095
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02362
NM
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
CNP02032
NM
Other
Enumeration date
02/25/2014
Last updated
10/27/2023
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