Provider Demographics
NPI:1578224275
Name:LARA, DANNA KAY (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DANNA
Middle Name:KAY
Last Name:LARA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 WATERHOLE CYN
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8409
Mailing Address - Country:US
Mailing Address - Phone:940-594-6415
Mailing Address - Fax:
Practice Address - Street 1:1745 AVENIDA DE MERCADO
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-224-2552
Practice Address - Fax:575-224-6858
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM66452363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics