Organization
DESERT SKIES FAMILY PRACTICE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ILANA CORNELIUS CNP (FAMILY NURSE PRACTITIONER)
(575) 437-1113
Entity
Organization
Contact information
Practice address
1101 9TH ST STE B, ALAMOGORDO, NM 88310-6432
(575) 437-1113
(575) 437-1777
Mailing address
1101 9TH ST STE B, ALAMOGORDO, NM 88310-6432
(575) 437-1113
(575) 437-1777
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R21461
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427011881
NPI TYPE I
—
05
—
89009851
—
NM
01
—
NM AAA2448
MEDICARE # I RECEIVED
NM
Enumeration date
10/24/2011
Last updated
03/26/2012
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