Provider Demographics
NPI:1003890195
Name:GALLARDO, ANITA C (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:C
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ANITAL
Other - Middle Name:C
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 DE MOSS ST
Mailing Address - Street 2:
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:88045-2618
Mailing Address - Country:US
Mailing Address - Phone:575-542-2369
Mailing Address - Fax:
Practice Address - Street 1:114 W 11TH ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-313-8234
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43351514Medicaid
Q34808Medicare UPIN
P00239832OtherRR MEDICARE