Provider Demographics
NPI:1023613239
Name:CLOW, CHRISTIANNA LEIGH (DN)
Entity type:Individual
Prefix:DR
First Name:CHRISTIANNA
Middle Name:LEIGH
Last Name:CLOW
Suffix:
Gender:F
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 SICILY RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4775
Mailing Address - Country:US
Mailing Address - Phone:505-331-9773
Mailing Address - Fax:
Practice Address - Street 1:2103 GOLF COURSE RD SE STE D
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1764
Practice Address - Country:US
Practice Address - Phone:505-331-9773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM01044172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath