| NPI | 1164194940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANNA RENE CLARK Co Owner/ Co Manager 505-366-3635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| 363LF0000X Nurse Practitioner, Family | |
| 163W00000X Registered Nurse | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-09-30 |