Provider Demographics
NPI:1750196275
Name:SECATERO, DARREN TYLER (LPN)
Entity type:Individual
Prefix:
First Name:DARREN
Middle Name:TYLER
Last Name:SECATERO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MEDICINE HORSE DR
Mailing Address - Street 2:
Mailing Address - City:CANONCITO
Mailing Address - State:NM
Mailing Address - Zip Code:87026
Mailing Address - Country:US
Mailing Address - Phone:505-908-2307
Mailing Address - Fax:
Practice Address - Street 1:129 MEDICINE HORSE DR.
Practice Address - Street 2:
Practice Address - City:TOHAJIILEE
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-908-2307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68008164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse