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General NPI Number Information
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NPI Number | 1144631052
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Entity Type | Organization
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Legal Business Name | ALAMOSA FOOT AND NAIL CARE MEDICAL SERVICES
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 1991 CARROLL ST
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City | ALAMOSA
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State | CO
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Zip | 81101-2003
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Country | US
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Telephone | 719-589-4952
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Fax | 719-589-5651
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Provider Business Mailing Address
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Address Line | PO BOX 732
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City | ALAMOSA
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State | CO
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Zip | 81101-0732
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Country | US
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Telephone | 281-684-9575
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Fax | 719-589-2246
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | CRYSTAL ANN BIRDSONG
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Credential | NP
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Telephone | 281-684-9575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0110549
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License Number State | CO
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