Healthcare Provider Details

I. General information

NPI: 1508643479
Provider Name (Legal Business Name): NEW MEXICO FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005A W US ROUTE 66
MORIARTY NM
87035-1007
US

IV. Provider business mailing address

PO BOX 2863
MORIARTY NM
87035-2863
US

V. Phone/Fax

Practice location:
  • Phone: 505-492-2541
  • Fax: 833-428-7070
Mailing address:
  • Phone: 505-492-2541
  • Fax: 833-428-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE NEUFELD
Title or Position: OWNER
Credential: NP
Phone: 505-492-2541