Organization
DESERT BLOOM TELEPSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA MARIE STANGER CNP (PMHNP-BC SOLE OWNER)
(505) 856-2262
Entity
Organization
Contact information
Practice address
8605 VINEYARD RIDGE RD NE, ALBUQUERQUE, NM 87122-2623
(505) 620-6389
Mailing address
8605 VINEYARD RIDGE RD NE, ALBUQUERQUE, NM 87122-2623
(505) 620-6389
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CNP-01597
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78935784
—
NM
Enumeration date
04/07/2016
Last updated
04/07/2016
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