Provider Demographics
NPI:1013273325
Name:HORTON, MAXINE ROSE (NP)
Entity Type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:ROSE
Last Name:HORTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAXINE
Other - Middle Name:ROSE
Other - Last Name:IGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:719 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-944-2021
Mailing Address - Fax:505-266-1710
Practice Address - Street 1:701 SAN MATEO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1434
Practice Address - Country:US
Practice Address - Phone:505-265-9511
Practice Address - Fax:505-268-4653
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01920363LW0102X
COAPN.0990300-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15222098Medicaid