Healthcare Provider Details

I. General information

NPI: 1972988392
Provider Name (Legal Business Name): CLARE MARIE IRONSIDE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARE MARIE XUEREB FNP-BC

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02703
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: