| Organization Name: | COTTONWOOD FAMILY MEDICINE LLC |
| NPI Number: | 1528429438 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATIE BOYLAN (SOLE MEMBER/NURSE PRACTITIONER) |
| Mailing Address: | 4940 Corrales Rd Suite 200 Corrales |
| State: | NM US |
| Postal Code: | 870488673 |
| Phone Number: | 5059290663 |
| Fax Number: | |
| NPI Enumeration Date: | 03/19/2016 |
| NPI Last Update Date: | 03/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | CNP02459 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |