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General NPI Number Information
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NPI Number | 1972177095
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Entity Type | Organization
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Legal Business Name | LAURA MCCLESKEY CFNP
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 3751 SOUTHERN BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-2084
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Country | US
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Telephone | 505-962-8503
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Fax | 505-962-8724
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Provider Business Mailing Address
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Address Line | 3751 SOUTHERN BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-2084
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Country | US
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Telephone | 505-962-8503
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Fax | 505-962-8724
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Authorized Official
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Title or Position | OWNER
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Name | LAURA MCCLESKY
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Credential | APRN
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Telephone | 505-306-2293
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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 |
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License Number State |
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