Healthcare Provider Details

I. General information

NPI: 1144089889
Provider Name (Legal Business Name): CRISTINA MCCLURE CHC, IHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5278 HWY 152
HANOVER NM
88041
US

IV. Provider business mailing address

2340 HIGHWAY 180 E # 209
SILVER CITY NM
88061-7782
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-4853
  • Fax:
Mailing address:
  • Phone: 575-313-4853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: