Healthcare Provider Details

I. General information

NPI: 1023613239
Provider Name (Legal Business Name): CHRISTIANNA LEIGH CLOW DN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 GOLF COURSE RD SE STE D
RIO RANCHO NM
87124-1764
US

IV. Provider business mailing address

5501 SICILY RD NW
ALBUQUERQUE NM
87114-4775
US

V. Phone/Fax

Practice location:
  • Phone: 505-331-9773
  • Fax:
Mailing address:
  • Phone: 505-331-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number01044
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: