Healthcare Provider Details

I. General information

NPI: 1669256590
Provider Name (Legal Business Name): NAHNSEJAY MOUWON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 UPTOWN BLVD NE
ALBUQUERQUE NM
87110-4159
US

IV. Provider business mailing address

7010 PHOENIX AVE NE APT 617
ALBUQUERQUE NM
87110-3507
US

V. Phone/Fax

Practice location:
  • Phone: 862-213-1474
  • Fax:
Mailing address:
  • Phone: 186-221-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number87965
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number84424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: