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NPI Profile for ACTIVE MEDICAL GROUP LLC in FARMINGTON, NM.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1992408520 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 03/23/2023 | |
| Last updated | 01/16/2025 - More than a year ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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ACTIVE MEDICAL GROUP LLC
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ACTIVE MEDICAL GROUP LLC