Healthcare Provider Details

I. General information

NPI: 1306545454
Provider Name (Legal Business Name): MARLENA R LEWIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 OSUNA RD NE
ALBUQUERQUE NM
87113-1002
US

IV. Provider business mailing address

2262 ESCUDO RD NE
RIO RANCHO NM
87124-8932
US

V. Phone/Fax

Practice location:
  • Phone: 505-300-1760
  • Fax: 505-217-0429
Mailing address:
  • Phone: 505-414-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number55291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: