Healthcare Provider Details

I. General information

NPI: 1053933721
Provider Name (Legal Business Name): CANU HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 CUTLER AVE NE
ALBUQUERQUE NM
87106-2511
US

IV. Provider business mailing address

2621 CUTLER AVE NE
ALBUQUERQUE NM
87106-2511
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-4223
  • Fax:
Mailing address:
  • Phone: 505-690-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER R O'DONNELL
Title or Position: CEO, FOUNDER
Credential: RN, PMHNP-BC
Phone: 505-690-4223