Healthcare Provider Details

I. General information

NPI: 1437459633
Provider Name (Legal Business Name): JENNETTE A COLE APRN, CFNP, MSN, RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNETTE A CLAY

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW SUITE 103
ALBUQUERQUE NM
87114-5916
US

IV. Provider business mailing address

5001 BRIGHTON HILLS DR NE
RIO RANCHO NM
87144-0823
US

V. Phone/Fax

Practice location:
  • Phone: 505-232-1100
  • Fax:
Mailing address:
  • Phone: 505-301-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: