| NPI | 1679865125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY LAFOND Provider Enrollment Coordinator 505-272-8950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LN0005X Nurse Practitioner, Neonatal, Critical Care (Licence: TX 612850) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-03 |