Organization
FLT LLC
Active
Other names
OCOTILLO FAMILY PRACTICE
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN WULF CNP (OWNER)
(575) 914-0055
Entity
Organization
Contact information
Practice address
313 W COUNTRY CLUB RD STE 15, ROSWELL, NM 88201-5804
(575) 914-0055
Mailing address
313 W COUNTRY CLUB RD STE 15, ROSWELL, NM 88201-5804
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP-02765
NM
Other
Enumeration date
09/14/2015
Last updated
09/14/2015
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