| NPI | 1033706924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KONTASHA SHAMIKA WISE Cnp, Pmhnp Bc 505-554-2681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2020-12-25 |
| Last Update Date | 2024-01-19 |