Healthcare Provider Details

I. General information

NPI: 1245639756
Provider Name (Legal Business Name): VACCINES FOR HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 LOUISIANA BLVD NE SUITE 212
ALBUQUERQUE NM
87110-7001
US

IV. Provider business mailing address

1717 LOUISIANA BLVD NE SUITE 212
ALBUQUERQUE NM
87110-7001
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-8785
  • Fax:
Mailing address:
  • Phone: 505-881-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number89-142
License Number StateNM

VIII. Authorized Official

Name: NANCI BALDWIN
Title or Position: OWNER
Credential: RN
Phone: 505-881-8785