Provider Demographics
NPI:1316569114
Name:SANCHEZ, DESIREE (NP-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 CALLE ACANTA NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5232
Mailing Address - Country:US
Mailing Address - Phone:505-922-1856
Mailing Address - Fax:
Practice Address - Street 1:200 EMILIO LOPEZ RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6818
Practice Address - Country:US
Practice Address - Phone:505-866-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59378363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner