Provider Demographics
NPI:1013410182
Name:ECONOPOULY, ANNE MARIE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:ECONOPOULY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 PECOS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3128
Mailing Address - Country:US
Mailing Address - Phone:505-385-0277
Mailing Address - Fax:
Practice Address - Street 1:833 PECOS LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3128
Practice Address - Country:US
Practice Address - Phone:505-385-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist