Healthcare Provider Details

I. General information

NPI: 1740635846
Provider Name (Legal Business Name): CADE CLINICAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CENTRAL AVE NW SUITE K-2
ALBUQUERQUE NM
87105-1630
US

IV. Provider business mailing address

2720 CENTRAL AVE SE SUITE G-606
ALBUQUERQUE NM
87106-2862
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-7250
  • Fax: 505-554-2313
Mailing address:
  • Phone: 216-374-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNMCNP-01942
License Number StateNM

VIII. Authorized Official

Name: JONATHAN CADE
Title or Position: OWNER
Credential: CNP
Phone: 216-374-9452