Individual
LINDA ELAINE WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
275 NEW MEXICO 3, RIBERA, NM 87560
(575) 421-1113
(575) 421-2943
Mailing address
PO BOX 158, 538 N. PASEO DE ONATE, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP00413
NM
363LF0000X
Family Nurse Practitioner
R23726
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44256779
—
NM
01
—
NM400316
MEDICARE PTAN
NM
Enumeration date
12/29/2008
Last updated
07/05/2013
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