| NPI | 1235026261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL FENTON Owner 505-315-1162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |