| NPI | 1316587942 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE DIANE MORMILE Owner/Nurse Practitioner 575-551-1183 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult |
| Enumeration Date | 2020-01-11 |
| Last Update Date | 2020-12-29 |