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1083264592
CLAY CHURCH
FARMINGTON, NM
NPI
1083264592
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: NM 57227)
Enumeration Date
2019-09-17
Last Update Date
2019-09-17
Business Address
CLAY CHURCH NP
801 W MAPLE ST
FARMINGTON, NM 87401-5630
Phone number: 505-609-2000
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Mailing Address
CLAY CHURCH NP
PO BOX 6210
FARMINGTON, NM 87499-6210
Phone number: 505-609-2258
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