Provider Demographics
NPI:1588018832
Name:SAN JOSE, MAYEDEL (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MAYEDEL
Middle Name:
Last Name:SAN JOSE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:MAYEDEL
Other - Middle Name:
Other - Last Name:BRIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1245 COUNTRY CLUB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9743
Mailing Address - Country:US
Mailing Address - Phone:575-332-4633
Mailing Address - Fax:
Practice Address - Street 1:1245 COUNTRY CLUB RD STE 200
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9743
Practice Address - Country:US
Practice Address - Phone:575-332-4633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130851363LF0000X
NMCNP-03155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily