Healthcare Provider Details

I. General information

NPI: 1114628013
Provider Name (Legal Business Name): ADAOBI ANABELLA EGWUONWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY OF NEW MEXICO # MS 095030
ALBUQUERQUE NM
87131-2174
US

IV. Provider business mailing address

320 PEQUIN TRL SE
ALBUQUERQUE NM
87123-2174
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2800
  • Fax:
Mailing address:
  • Phone: 505-210-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number55317
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: