Healthcare Provider Details

I. General information

NPI: 1124576327
Provider Name (Legal Business Name): CLAY SCHNEIDER CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

PO BOX 4562
ALBUQUERQUE NM
87196-4562
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-8378
  • Fax:
Mailing address:
  • Phone: 505-270-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02991
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: