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General NPI Number Information
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NPI Number | 1366773947
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Entity Type | Organization
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Legal Business Name | UPPER VALLEY MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 01/21/2010
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Last Update Date | 01/21/2010
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Provider Practice Location Address
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Address Line | 950 ANTHONY ST
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City | CANUTILLO
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State | TX
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Zip | 79835-6052
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Country | US
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Telephone | 915-877-4217
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Fax | 915-877-4231
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Provider Business Mailing Address
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Address Line | 7250 NINTH ST
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City | CANUTILLO
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State | TX
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Zip | 79835-6011
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Country | US
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Telephone | 915-877-4217
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Fax | 915-877-4231
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. ANNA M LUCERO
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Credential | FNP-C
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Telephone | 915-877-4217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 537539
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License Number State | TX
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