Individual
MARA TRAINER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
(505) 661-8916
Mailing address
3917 WEST RD STE A, LOS ALAMOS, NM 87544-2292
(505) 661-8900
(505) 661-8916
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-03443
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
850434082
TAX IDENTIFICATION NUMBER
NM
Enumeration date
01/05/2007
Last updated
11/10/2017
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