Healthcare Provider Details

I. General information

NPI: 1801663604
Provider Name (Legal Business Name): NANCY ANN CAMPANOZZI MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 CANDELARIA RD NE STE 122
ALBUQUERQUE NM
87107-1968
US

IV. Provider business mailing address

5001 BLUE STONE RD NW
ALBUQUERQUE NM
87114-2023
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-4361
  • Fax:
Mailing address:
  • Phone: 505-681-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2023-0282
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: