Provider Demographics
NPI:1932548153
Name:ESTES, MARY L (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:ESTES
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CFNP
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 1:1701 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6114
Practice Address - Country:US
Practice Address - Phone:575-630-1055
Practice Address - Fax:575-630-1066
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily