| NPI | 1033706924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KONTASHA SHAMIKA WISE Cnp, Pmhnp Bc 505-554-8315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 363LA2200X Nurse Practitioner Adult Health | |
| Enumeration Date | 2020-12-25 |
| Last Update Date | 2024-07-26 |