Provider Demographics
NPI:1811025331
Name:ANAYA, RONDA RENEE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:RENEE
Last Name:ANAYA
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 1:1216 CAMEO ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5571
Mailing Address - Country:US
Mailing Address - Phone:575-763-5583
Mailing Address - Fax:575-763-1842
Practice Address - Street 1:1216 CAMEO ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5571
Practice Address - Country:US
Practice Address - Phone:575-763-5583
Practice Address - Fax:575-763-1842
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12674711Medicaid