Provider Demographics
NPI:1639255300
Name:POSTL, ANTJE (RN, CFNP)
Entity Type:Individual
Prefix:
First Name:ANTJE
Middle Name:
Last Name:POSTL
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CAMINO DE VIDA
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-2267
Mailing Address - Country:US
Mailing Address - Phone:575-472-4311
Mailing Address - Fax:575-472-4313
Practice Address - Street 1:117 CAMINO DE VIDA
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2267
Practice Address - Country:US
Practice Address - Phone:575-472-4311
Practice Address - Fax:575-472-4313
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR35159363LF0000X
NMCNP00741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000138687Medicaid
NM000138687Medicaid
NMR35159OtherNM PROFF. NURSING LIC.