Provider Demographics
NPI:1679655955
Name:ANLLO, PILAR MARIE (NP)
Entity Type:Individual
Prefix:MS
First Name:PILAR
Middle Name:MARIE
Last Name:ANLLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HOSPITAL DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4769
Mailing Address - Country:US
Mailing Address - Phone:505-989-1975
Mailing Address - Fax:505-467-8666
Practice Address - Street 1:1650 HOSPITAL DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4769
Practice Address - Country:US
Practice Address - Phone:505-989-1975
Practice Address - Fax:505-467-8666
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10685OtherPHP PROVIDER#
NMNM01R83HOtherBCBS PROVIDER#
NM0008999972Medicaid
NM10685OtherPHP PROVIDER#
NM339419401Medicare PIN