| NPI | 1659800894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE EVA WILLIS Owner 505-994-4503 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP-0216) |
| Enumeration Date | 2017-06-10 |
| Last Update Date | 2017-06-10 |