Provider Demographics
NPI:1669921003
Name:TSO, LAPRINCESS D
Entity type:Individual
Prefix:
First Name:LAPRINCESS
Middle Name:D
Last Name:TSO
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:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-6595
Mailing Address - Fax:505-609-6579
Practice Address - Street 1:735 W ANIMAS ST STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5616
Practice Address - Country:US
Practice Address - Phone:505-609-2880
Practice Address - Fax:505-609-2882
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner