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General NPI Number Information
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NPI Number | 1144529694
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Entity Type | Organization
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Legal Business Name | CLITEPIC LLC
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 01/25/2013
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Provider Practice Location Address
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Address Line | 700 HIGH ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2565
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Country | US
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Telephone | 505-401-0810
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Fax | 505-858-1467
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Provider Business Mailing Address
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Address Line | 12231 ACADEMY RD NE #301-223
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-7236
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Country | US
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Telephone | 505-792-6590
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Fax | 505-858-1467
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Authorized Official
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Title or Position | ACUTE CARE NURSE PRACTITIONER
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Name | SOPHIA CHU RODGERS
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Credential | MSN, ACNP-C,FNP-C,
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Telephone | 505-401-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | CNP00285
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License Number State | NM
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