Organization
KNACKSTEDT MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIRLEY KNACKSTEDT CNP (CO-OWNER)
(505) 730-5603
Entity
Organization
Contact information
Practice address
7218 4TH ST NW, LOS RANCHOS, NM 87107-6624
(505) 730-5603
(505) 554-2313
Mailing address
7218 4TH ST NW, LOS RANCHOS, NM 87107-6624
(505) 730-5603
(505) 554-2313
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/17/2016
Last updated
03/17/2016
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