Healthcare Provider Details

I. General information

NPI: 1306881222
Provider Name (Legal Business Name): KAREN SUE CLELAND RD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE NEW MEXICO VA HEALTH CARE SYSTEM
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

2120 WISCONSIN ST NE
ALBUQUERQUE NM
87110-4750
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-6414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: