Healthcare Provider Details

I. General information

NPI: 1285219527
Provider Name (Legal Business Name): JOSHUA NKEMKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 MONTCLAIRE DR NE
ALBUQUERQUE NM
87110-1723
US

IV. Provider business mailing address

3115 MONTCLAIRE DR NE
ALBUQUERQUE NM
87110-1723
US

V. Phone/Fax

Practice location:
  • Phone: 505-730-9754
  • Fax:
Mailing address:
  • Phone: 505-730-9754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3618
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: