Healthcare Provider Details

I. General information

NPI: 1841322641
Provider Name (Legal Business Name): UNM MEDICALLY FRAGILE CASE MANAGEMENT PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

IV. Provider business mailing address

2300 MENAUL BLVD NE
ALBUQUERQUE NM
87107-1851
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2910
  • Fax: 505-272-8100
Mailing address:
  • Phone: 505-272-2910
  • Fax: 505-272-8100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR14178
License Number StateNM

VIII. Authorized Official

Name: MRS. CHRISTINA M. BARDEN
Title or Position: PROGRAM OPERATIONS DIRECTOR
Credential: R.N.
Phone: 505-272-2757