Healthcare Provider Details

I. General information

NPI: 1659805505
Provider Name (Legal Business Name): NEW MEXICO HEALTH CARE CLINICIANS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 4TH ST NW SUITE A
ALBUQUERQUE NM
87107-2510
US

IV. Provider business mailing address

3911 4TH ST NW SUITE A
ALBUQUERQUE NM
87107-2510
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-0375
  • Fax:
Mailing address:
  • Phone: 505-480-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberRN 14825
License Number StateNM

VIII. Authorized Official

Name: AUTUMN L PIERCE
Title or Position: PRESIDENT
Credential:
Phone: 505-480-0375