Individual
LAURA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
Mailing address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R31992
NM
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
R31992
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265683049
OPTUM
NM
Enumeration date
10/11/2016
Last updated
10/11/2016
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