Healthcare Provider Details

I. General information

NPI: 1497573422
Provider Name (Legal Business Name): EDWARD PILIMOO FAAGAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WAKI FAAGAI C-FNP

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8888
  • Fax: 505-823-8238
Mailing address:
  • Phone: 505-823-8888
  • Fax: 505-823-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number82249
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: