Healthcare Provider Details

I. General information

NPI: 1972177095
Provider Name (Legal Business Name): LAURA MCCLESKEY CFNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 SOUTHERN BLVD SE
RIO RANCHO NM
87124-2084
US

IV. Provider business mailing address

3751 SOUTHERN BLVD SE
RIO RANCHO NM
87124-2084
US

V. Phone/Fax

Practice location:
  • Phone: 505-962-8503
  • Fax: 505-962-8724
Mailing address:
  • Phone: 505-962-8503
  • Fax: 505-962-8724

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: LAURA MCCLESKY
Title or Position: OWNER
Credential: APRN
Phone: 505-306-2293