| NPI | 1942028147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLYSSA TEDDER Nurse Practitioner 505-920-0087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |