Organization
NM SMALL TOWN FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANNA R CLARK NP (OWNER/PROVIDER)
(505) 366-3635
Entity
Organization
Contact information
Practice address
4225 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1103
(505) 366-3635
(505) 392-3878
Mailing address
2000 LAM CT NE, RIO RANCHO, NM 87144-7775
(575) 621-3940
(505) 392-3878
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
02/24/2022
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