Healthcare Provider Details

I. General information

NPI: 1497646343
Provider Name (Legal Business Name): MARSELINA PACHECO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 MONTGOMERY BLVD NE
ALBUQUERQUE NM
87111-2468
US

IV. Provider business mailing address

1700 COOKE CANYON DR NW
ALBUQUERQUE NM
87120-6224
US

V. Phone/Fax

Practice location:
  • Phone: 505-298-2505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84559
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: