Provider Demographics
NPI:1821788837
Name:REGALADO, DANIELLE M (NP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:REGALADO
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:626 TAFT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NM
Practice Address - Zip Code:88029
Practice Address - Country:US
Practice Address - Phone:575-531-2165
Practice Address - Fax:575-531-2172
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75899363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty