Individual
MS. THERESA ANN BUBENZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
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
163W00000X
Registered Nurse
RN-75785
NM
363L00000X
Nurse Practitioner
Primary
CNP-01998
NM
363LF0000X
Family Nurse Practitioner
71002349A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71002349A
NP LICENSE
IN
01
—
CNP-01998
STATE LICENSE
NM
Enumeration date
03/01/2007
Last updated
09/23/2015
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