Healthcare Provider Details

I. General information

NPI: 1649712886
Provider Name (Legal Business Name): JOANNE CLINTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNE FRASCHILLA

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

5203 JUAN TABO BLVD NE STE 2B
ALBUQUERQUE NM
87111-2691
US

V. Phone/Fax

Practice location:
  • Phone: 505-555-5555
  • Fax:
Mailing address:
  • Phone: 505-657-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-03095
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP-03095
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: