Healthcare Provider Details

I. General information

NPI: 1295220457
Provider Name (Legal Business Name): REBECCA ECHOLS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87109-1219
US

IV. Provider business mailing address

311 WALTER ST SE APT B
ALBUQUERQUE NM
87102-4089
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-7800
  • Fax:
Mailing address:
  • Phone: 316-393-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: