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General NPI Number Information
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NPI Number | 1720606882
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Entity Type | Organization
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Legal Business Name | MOUNTAIN DESERT HEALTH CLINIC LLC
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Dates
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Enumeration Date | 07/06/2020
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 4411 MONTANO RD NW STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-3235
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Country | US
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Telephone | 505-597-0936
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Fax | 505-458-0673
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Provider Business Mailing Address
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Address Line | 4411 MONTANO RD NW STE F
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-3235
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Country | US
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Telephone | 505-597-0936
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Fax | 505-457-0673
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Authorized Official
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Title or Position | OWNER
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Name | SHARON SCHAAF
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Credential | NP
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Telephone | 505-597-0936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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