Healthcare Provider Details

I. General information

NPI: 1144519752
Provider Name (Legal Business Name): NATASHA A WELLS D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4916 4TH ST NW
ALBUQUERQUE NM
87107-3949
US

IV. Provider business mailing address

PO BOX 2806
CORRALES NM
87048-2806
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-8008
  • Fax:
Mailing address:
  • Phone: 505-328-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1049
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: