Healthcare Provider Details

I. General information

NPI: 1174343933
Provider Name (Legal Business Name): WYCO-CARE, APRN, NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SAN PEDRO DR NE
ALBUQUERQUE NM
87110-6723
US

IV. Provider business mailing address

1209 MOUNTAIN ROAD PL NE # 8085
ALBUQUERQUE NM
87110-7845
US

V. Phone/Fax

Practice location:
  • Phone: 505-658-8898
  • Fax: 505-499-4988
Mailing address:
  • Phone:
  • 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: FREDERICK WYCOCO
Title or Position: PRESIDENT
Credential: NP
Phone: 505-658-8898