Healthcare Provider Details

I. General information

NPI: 1598624926
Provider Name (Legal Business Name): NICK PANNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CLARK DR
ALBUQUERQUE NM
87124
US

IV. Provider business mailing address

10547 BROOKLINE PL NW
ALBUQUERQUE NM
87114-3715
US

V. Phone/Fax

Practice location:
  • Phone: 505-742-1421
  • Fax:
Mailing address:
  • Phone: 386-405-3017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: