Provider Demographics
NPI:1740731033
Name:MADRID, SAMANTHA M (BCNP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:M
Last Name:MADRID
Suffix:
Gender:F
Credentials:BCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 CORN MOUNTAIN PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6079
Mailing Address - Country:US
Mailing Address - Phone:505-323-7769
Mailing Address - Fax:
Practice Address - Street 1:5909 ALICE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6501
Practice Address - Country:US
Practice Address - Phone:505-200-2927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily