Organization
IMMEDICARE CARE CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARILYN NISHITANI FNP (OWNER)
(505) 630-5300
Entity
Organization
Contact information
Practice address
721 MECHEM DR, SIERRA MALL, RUIDOSO, NM 88345-6911
(505) 630-5300
(505) 630-5301
Mailing address
721 MECHEM DR, SIERRA MALL, RUIDOSO, NM 88345-6911
(505) 630-5300
(505) 630-5301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36888257
—
NM
Enumeration date
08/16/2005
Last updated
08/22/2020
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