Healthcare Provider Details

I. General information

NPI: 1578798195
Provider Name (Legal Business Name): MARGIE J WESLEY DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 ACADEMY NE
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

6237 VANCE RD STE 4
CHATTANOOGA TN
37421-2954
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-0308
  • Fax:
Mailing address:
  • Phone: 423-596-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number997
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: