Healthcare Provider Details

I. General information

NPI: 1316452972
Provider Name (Legal Business Name): C BELCHER MSN, RN, FNP-BC, CEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 FRED DAUGHERTY AVE
CLOVIS NM
88101-8615
US

IV. Provider business mailing address

2513 FRED DAUGHERTY AVE
CLOVIS NM
88101-8615
US

V. Phone/Fax

Practice location:
  • Phone: 575-760-0160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65513
License Number StateNM

VIII. Authorized Official

Name: CONSTANCE C BELCHER
Title or Position: OWNER/PROVIDER
Credential:
Phone: 575-760-0160