Healthcare Provider Details

I. General information

NPI: 1073123063
Provider Name (Legal Business Name): WASAN CARTWRIGHT JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 09/08/2021
Certification Date: 08/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7005 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

IV. Provider business mailing address

7005 PROSPECT PL NE
ALBUQUERQUE NM
87110-4311
US

V. Phone/Fax

Practice location:
  • Phone: 505-361-2634
  • Fax: 505-503-1277
Mailing address:
  • Phone: 505-361-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60994
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: