MRS. LORENA CARRILLO HENDERSON (NPI# 1013286830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013286830 |
| Entity Type | Individual |
| Full Name | MRS. LORENA CARRILLO HENDERSON |
| Credential | RN, FNP-C |
| Practice Address |
1245 Country Club Rd Suite 200 Santa Teresa NM 88008-9743 |
| Mailing Address |
14470 Horizon Blvd Ste J Horizon City TX 79928-7696 |
| Practice Telephone | 9156137716 |
| Mailing Telephone | 9157779075 |
| Mailing Fax Number | 8777616002 |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2017-04-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
607418 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
CNP-02601 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1245 COUNTRY CLUB RD SUITE 200 |
| City | SANTA TERESA |
| State | NM |
| Zip Code | 88008-9743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699799684 | Tanya Veronica Marin | Nurse Practitioner | 1245 Country Club Rd, Suite 200, Santa Teresa, NM 88008-9743 | 2006-07-26 |
| 1720469679 | Tanya V Marin, PC | Clinic/Center | 1245 Country Club Rd, Suite 200, Santa Teresa, NM 88008-9743 | 2015-06-17 |
| 1316339948 | Sandra L Shuya PC | Community/Behavioral Health | 1245 Country Club Rd, Ste. 200, Santa Teresa, NM 88008-9743 | 2015-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507211 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 5690 Santa Teresita Drive, Suite A2, Room P1, Santa Teresa, NM 88008 | 2020-10-27 |
| 1891848131 | Direct Healthcare South Inc | Home Health | 101 Livingston Loop, Suite 5, Santa Teresa, NM 88008 | 2007-01-19 |
| 1912061235 | Rio Valle Behavioral Health Centre | Psychiatry & Neurology | 101 Livinston Loop, Bldg C Suite 3, Santa Teresa, NM 88008 | 2006-12-21 |
| 1679634562 | Robert L Nichols | Family Medicine | 1300 Country Club Road, Santa Teresa, NM 88008 | 2006-12-13 |
| 1881792950 | Leo J Raschbaum Mdpc | Clinic/Center | 5690 Santa Teresita, Building A, Suite 4, Santa Teresa, NM 88008 | 2006-09-20 |
| 1366410276 | Emilio T. Rivera | Anesthesiology | 5290 Mcnutt Rd, Ste 109, Santa Teresa, NM 88008 | 2006-03-08 |
| 1225486194 | Diane Rivera | Registered Nurse | 101 Airport Road, Santa Teresa, NM 88008 | 2016-06-01 |
| 1780080358 | Audriana Apodaca | Nurse Practitioner | 100 Airport Rd, Santa Teresa, NM 88008 | 2014-11-10 |
| 1447667001 | Noha Oushy Eissa | Dentist | 103 Livingston Loop Ste B3, Santa Teresa, NM 88008 | 2014-07-16 |
| 1871963017 | Oralia Quezada | Student in an Organized Health Care Education/Training Program | 103 Livingston Loop, Bldg B, Suite 4, Santa Teresa, NM 88008-1063 | 2015-09-30 |
| Find all providers in zip 88008 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808126 | Compassion Docs LLC | Nurse Practitioner | 8100 Wyoming Blvd Ne Ste M-4302, Albuquerque, NM 87113-1946 | 2020-10-11 |
| 1598398216 | Melissa Rose Pino | Nurse Practitioner | 10855 Firenze Dr Nw, Albuquerque, NM 87114-5287 | 2020-02-20 |
| 1043857410 | Elizabeth F Baca | Nurse Practitioner | 2502 Marble Ave, Albuquerque, NM 87131-0001 | 2019-12-04 |
| 1386108546 | Patricia Shepard | Nurse Practitioner | 1410 N 8th St Ste B, Carlsbad, NM 88220-3217 | 2019-01-22 |
| 1376945261 | Kenneth Smith II | Nurse Practitioner | 224 W D. L. Ingram Ave, Cannon Afb, NM 88103-5103 | 2014-09-23 |
| 1023255510 | Valencia Family Medicine & Express Care | Nurse Practitioner | 311 S. Los Lentes, Los Lunas, NM 87031 | 2009-01-21 |
| 1356358477 | Mary Louise Blankenship | Nurse Practitioner | 3200 La Orilla Rd Nw, Albuquerque, NM 87120-2742 | 2006-08-02 |
| 1861093825 | Lesley Roller | Nurse Practitioner | 328 Main St Ne, Los Lunas, NM 87031-7454 | 2020-11-05 |
| 1003415753 | Jessica Wood | Nurse Practitioner | 1400 Main St Nw, Los Lunas, NM 87031-4812 | 2020-10-23 |
| 1023620143 | Chona Miller | Nurse Practitioner | 1500 Lomas Blvd Nw, Albuquerque, NM 87104-1200 | 2020-08-19 |
| Find all providers with the same taxonomy | ||||
| City | SANTA TERESA |
| Zip Code | 88008 |
Please comment or provide details below to improve the information on MRS. LORENA CARRILLO HENDERSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.