Healthcare Provider Details

I. General information

NPI: 1871500827
Provider Name (Legal Business Name): AMY WEISS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 ZUNI RD. SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

5608 ZUNI RD SE
ALBUQUERQUE NM
87108-2926
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-6560
  • Fax: 505-265-7045
Mailing address:
  • Phone: 505-262-6560
  • Fax: 505-265-7045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR31246
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: