Individual
SHIRLEY KNACKSTEDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
7218 4TH ST NW, LOS RANCHOS, NM 87107-6624
(505) 730-5603
(505) 554-2313
Mailing address
7218 4TH ST NW, LOS RANCHOS, NM 87107-6624
(505) 730-5603
(505) 554-2313
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R39671/CNP00873
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K3771
—
NM
Enumeration date
11/10/2005
Last updated
04/04/2016
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