Healthcare Provider Details

I. General information

NPI: 1952181893
Provider Name (Legal Business Name): JOSEPHINE SANDERS-SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5066
US

IV. Provider business mailing address

1336 WYOMING BLVD NE
ALBUQUERQUE NM
87112-5066
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-7533
  • Fax:
Mailing address:
  • Phone: 505-690-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number166679
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: