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General NPI Number Information
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NPI Number | 1972219210
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Entity Type | Individual
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Provider Name | ALISH MCBRIDE CASSIDY
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Gender | Female
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 5550 WYOMING BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3167
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Country | US
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Telephone | 443-926-6537
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Fax |
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Provider Business Mailing Address
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Address Line | 713 INDIANA ST SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-3812
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 57322
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License Number State | NM
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