Healthcare Provider Details

I. General information

NPI: 1598098659
Provider Name (Legal Business Name): HEIDI ELIZABETH WAHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 COORS BYP NW
ALBUQUERQUE NM
87114-4040
US

IV. Provider business mailing address

1119 CAMINO DE LA JARA
EL PRADO NM
87529-6040
US

V. Phone/Fax

Practice location:
  • Phone: 505-677-0988
  • Fax:
Mailing address:
  • Phone: 505-795-4413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2026-0571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: