Healthcare Provider Details

I. General information

NPI: 1740964923
Provider Name (Legal Business Name): MINDREMEDI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 4TH ST NW
ALBUQUERQUE NM
87102-5324
US

IV. Provider business mailing address

500 4TH ST NW STE 102
ALBUQUERQUE NM
87102-2104
US

V. Phone/Fax

Practice location:
  • Phone: 707-639-3463
  • Fax:
Mailing address:
  • Phone: 707-639-3463
  • 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: STEPHANIE ARMENTA
Title or Position: BILLING/CREDENTIALING SPECIALIST
Credential: CPB
Phone: 228-334-6609