| Lifted Clinical Practice, Pllc | |
|
2801 Rodeo Rd Ste C14 Santa Fe NM 87507-6503 | |
| (505) 430-0760 | |
| (866) 354-3833 |
| Full Name | Lifted Clinical Practice, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2801 Rodeo Rd Ste C14, Santa Fe, New Mexico |
| Authorized Official Name and Position | Funmilayo Aina (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 5054300760 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifted Clinical Practice, Pllc 2801 Rodeo Rd Ste C14 Santa Fe NM 87507-6503 Ph: (505) 430-0760 | Lifted Clinical Practice, Pllc 2801 Rodeo Rd Ste C14 Santa Fe NM 87507-6503 Ph: (505) 430-0760 |
| NPI Number | 1447797758 |
|---|---|
| Provider Enumeration Date | 01/24/2017 |
| Last Update Date | 09/08/2022 |
| Medicare PECOS PAC ID | 1850678301 |
|---|---|
| Medicare Enrollment ID | O20170510001284 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447797758 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QC1500X | Clinic/center - Community Health | AP123182 (Texas) | Secondary |
| 261QC1500X | Clinic/center - Community Health | 688447 (Texas) | Primary |
| Provider Name | Funmilayo Aina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295078335 PECOS PAC ID: 5294774436 Enrollment ID: I20130904000681 |
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