Healthcare Provider Details

I. General information

NPI: 1851377667
Provider Name (Legal Business Name): INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-4065
  • Fax: 505-248-4088
Mailing address:
  • Phone: 505-248-4065
  • Fax: 505-248-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License NumberR29941
License Number StateNM

VIII. Authorized Official

Name: MS. ROSE ROWAN
Title or Position: NURSE PRACTITIONER
Credential: NURSE PRACTITIONER
Phone: 505-248-4065