Healthcare Provider Details

I. General information

NPI: 1750922241
Provider Name (Legal Business Name): TENZIN YANGCHEN FNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-3102
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2500
  • Fax: 505-291-2552
Mailing address:
  • Phone: 505-923-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57882
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: