Healthcare Provider Details

I. General information

NPI: 1407392632
Provider Name (Legal Business Name): RUTH NYANG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 GREENE ST NW STE 311
ALBUQUERQUE NM
87114-4284
US

IV. Provider business mailing address

4611 GREENE ST NW STE 311
ALBUQUERQUE NM
87114-4284
US

V. Phone/Fax

Practice location:
  • Phone: 505-926-2999
  • Fax: 505-485-0610
Mailing address:
  • Phone: 505-926-2999
  • Fax: 505-485-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: