Healthcare Provider Details

I. General information

NPI: 1609165067
Provider Name (Legal Business Name): HEALTHNET MEDICAL FAMILY & INTERNAL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MCCOMBS RD # 235
CHAPARRAL NM
88081-7937
US

IV. Provider business mailing address

300 MCCOMBS RD # 235
CHAPARRAL NM
88081-7937
US

V. Phone/Fax

Practice location:
  • Phone: 915-920-7783
  • Fax: 866-596-6125
Mailing address:
  • Phone: 915-920-7783
  • Fax: 866-596-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01432
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number658423
License Number StateTX

VIII. Authorized Official

Name: MS. MARIA ADELINA FRISBIE-VEAL
Title or Position: OWNER
Credential: FNP-C
Phone: 915-920-7783