Organization
SMALL TOWN FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA RENE CLARK NURSE PRACTITIONER (CO-OWNER/ CO-MANAGER)
(505) 366-3635
Entity
Organization
Contact information
Practice address
4225 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1103
(505) 366-3635
(505) 221-5429
Mailing address
4225 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1103
(505) 366-3635
(505) 221-5429
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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