Healthcare Provider Details

I. General information

NPI: 1982825667
Provider Name (Legal Business Name): NANULIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/23/2010
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
87110-4058
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-8785
  • Fax: 505-872-8785
Mailing address:
  • Phone: 505-881-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number03-035189-008
License Number StateNM

VIII. Authorized Official

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