Provider Demographics
NPI:1952742173
Name:MARY L. ESTES, CFNP, LLC
Entity Type:Organization
Organization Name:MARY L. ESTES, CFNP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE-ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:575-937-2516
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-0009
Mailing Address - Country:US
Mailing Address - Phone:575-630-1055
Mailing Address - Fax:575-630-1066
Practice Address - Street 1:106 BEULAH LANE
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88355-0009
Practice Address - Country:US
Practice Address - Phone:575-630-1055
Practice Address - Fax:575-630-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02204261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center