Healthcare Provider Details

I. General information

NPI: 1487150330
Provider Name (Legal Business Name): NIKHILA THAMMINENI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE BLDG D HEMATOLOGY/ONCOLOGY
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-6100
  • Fax: 505-559-6101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD2023-1487
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: