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General NPI Number Information
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NPI Number | 1962714410
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Entity Type | Organization
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Legal Business Name | CLOVIS QUICKCARE LLC
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 2000 W 21ST ST STE E3
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City | CLOVIS
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State | NM
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Zip | 88101-4093
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Country | US
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Telephone | 575-769-2533
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Fax | 575-769-1735
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Provider Business Mailing Address
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Address Line | 2000 W 21ST ST STE E3
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City | CLOVIS
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State | NM
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Zip | 88101-4093
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Country | US
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Telephone | 575-769-2533
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Fax | 575-769-1735
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEBRA LEE CYPHERT
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Credential | FNP-BC
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Telephone | 575-769-2533
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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 | 0383007
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License Number State | NM
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