Provider Demographics
NPI:1609165067
Name:HEALTHNET MEDICAL FAMILY & INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:HEALTHNET MEDICAL FAMILY & INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ADELINA
Authorized Official - Last Name:FRISBIE-VEAL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:915-920-7783
Mailing Address - Street 1:300 MCCOMBS RD # 235
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7937
Mailing Address - Country:US
Mailing Address - Phone:915-920-7783
Mailing Address - Fax:866-596-6125
Practice Address - Street 1:300 MCCOMBS RD # 235
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7937
Practice Address - Country:US
Practice Address - Phone:915-920-7783
Practice Address - Fax:866-596-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01432363LF0000X
TX658423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty