Individual
ELAINE BECKER STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC,ACNP-BC, CCNS
Contact information
Practice address
1101 MEDICAL ARTS AVE NE, BUILDING 4 SUITE A, ALBUQUERQUE, NM 87102-2706
(505) 272-2273
(505) 272-2075
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R60088
NM
363LA2200X
Adult Health Nurse Practitioner
R60088
NM
Other
Enumeration date
07/06/2007
Last updated
06/05/2012
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