Healthcare Provider Details

I. General information

NPI: 1740155589
Provider Name (Legal Business Name): DAVID MCALLISTER WITHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

1709 RICHMOND DR NE
ALBUQUERQUE NM
87106-1724
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberR63847
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: