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General NPI Number Information
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NPI Number | 1679264634
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Entity Type | Organization
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Legal Business Name | MICHELLE COREY ENT. INC.
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 509 VISTA RIDGE RD
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City | TAOS
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State | NM
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Zip | 87571-6781
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Country | US
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Telephone | 575-613-4369
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Fax | 866-686-3415
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Provider Business Mailing Address
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Address Line | 509 VISTA RIDGE RD
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City | TAOS
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State | NM
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Zip | 87571-6781
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Country | US
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Telephone | 575-613-4369
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Fax | 866-686-3415
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. MICHELLE CHRISTINE COREY
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Credential | FMP
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Telephone | 575-613-4369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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