Healthcare Provider Details

I. General information

NPI: 1669482246
Provider Name (Legal Business Name): JOYCE ELIZABETH WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SUMMER NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

6000 SUMMER NE
ALBUQUERQUE NM
87110
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-3785
  • Fax:
Mailing address:
  • Phone: 505-265-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-0672
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: