Individual
CARLA L. VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
PHS WOUND CLINIC, 5901 HARPER DRIVE NE, ALBUQUERQUE, NM 87109
(505) 823-8870
(505) 823-8875
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
R31478
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37027859
—
NM
Enumeration date
10/03/2006
Last updated
10/29/2009
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