Priscilla T Carrillo, RN
Individual provider Active NPI Ambulatory Care Registered Nurse · Dulce, NM
NPI 1922022995 · NPPES record last updated Sep 15, 2010
Key facts
- NPI
- 1922022995
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ambulatory Care Registered Nurse 163WP2201X
- License
- R53479 (NM)
- Practice address
- 12000 Stone Lake Rd.
Dulce, NM 87528 - Phone
- (575) 759-3291
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R53479 | NM | MD | Ambulatory Care Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS/IHS/Aao/Jsu/Dulce Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Care Registered Nurse | 163WP2201X | R53479 | NM | Yes |
Addresses
Primary practice location
12000 Stone Lake Rd.
Dulce, NM 87528
Mailing address
HC 75 Box 53a
Chama, NM 87520-9702
Phone (505) 929-4962
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00K3526 | Medicaid | NM | |
| HSZ196 | Other | NM | MEDICARE PART B |
Other providers in Dulce, NM
- Sirpa T. Autio
- Nicholas Robbert Ayres
- Katherine E Berry
- Maricela Bonilla
- Joshua Greer Carney
- Cecilia E. Chao
- Raquel Irene Cisneros
- Jennifer Lea Lea Claycomb
- Diana Connell
- Susan Constance
All providers in Dulce, NM · Ambulatory Care Registered Nurse in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.