Healthcare Provider Details

I. General information

NPI: 1679265227
Provider Name (Legal Business Name): SAVANNAH WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RIO GRANDE BLVD NW
ALBUQUERQUE NM
87104-2057
US

IV. Provider business mailing address

224 RICHMOND DR SE
ALBUQUERQUE NM
87106-2238
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-0807
  • Fax:
Mailing address:
  • Phone: 505-803-6873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: