Provider Demographics
NPI:1861429375
Name:LANDAU, NAOMI (CFNP)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WHS 901 W.ALAMEDA STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1673
Mailing Address - Country:US
Mailing Address - Phone:505-955-9421
Mailing Address - Fax:505-982-7321
Practice Address - Street 1:WHS 901 W.ALAMEDA STREET
Practice Address - Street 2:SUITE 25
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1673
Practice Address - Country:US
Practice Address - Phone:505-955-9421
Practice Address - Fax:505-982-7321
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR19367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS48865Medicare UPIN