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General NPI Number Information
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NPI Number | 1407035124
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Entity Type | Organization
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Legal Business Name | CLINIMED CORPORATION
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 6570 4TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-5813
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Country | US
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Telephone | 505-345-3800
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Fax | 505-345-7840
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Provider Business Mailing Address
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Address Line | 6570 4TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-5813
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Country | US
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Telephone | 505-345-3800
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Fax | 505-345-7840
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD MERLE HATHAWAY
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Credential | C.N.P.
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Telephone | 505-345-3800
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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 | R 14825
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License Number State | NM
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