Healthcare Provider Details

I. General information

NPI: 1922612985
Provider Name (Legal Business Name): CLAIRE JUDITH MELGAARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 09/06/2020
Certification Date: 09/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

8205 TINA DR NE
ALBUQUERQUE NM
87109-5236
US

V. Phone/Fax

Practice location:
  • Phone: 505-867-2324
  • Fax:
Mailing address:
  • Phone: 505-463-4465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: