Organization
FOUR CORNERS NEPHROLOGY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BILLIE STOLWORTHY (OFFICE MANAGER)
(505) 326-6521
Entity
Organization
Contact information
Practice address
622 W MAPLE ST STE H, FARMINGTON, NM 87401-6589
(505) 326-6521
(505) 325-6699
Mailing address
622 W MAPLE ST STE H, FARMINGTON, NM 87401-6589
(505) 326-6521
(505) 325-6699
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
311843
—
AZ
05
—
94004736
—
CO
05
—
F3805
—
NM
Enumeration date
09/20/2006
Last updated
04/01/2011
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