Healthcare Provider Details

I. General information

NPI: 1245869130
Provider Name (Legal Business Name): INDIGO PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GOLD AVE SW STE 1-C
ALBUQUERQUE NM
87102-3119
US

IV. Provider business mailing address

609 GOLD AVE SW STE 1-C
ALBUQUERQUE NM
87102-3119
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-3541
  • Fax:
Mailing address:
  • Phone: 505-620-3541
  • 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: NANCY ROOPE
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 505-620-3541