Healthcare Provider Details

I. General information

NPI: 1942066436
Provider Name (Legal Business Name): CHOCOLATE BRAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CATRON AVE SE
ALBUQUERQUE NM
87123-4227
US

IV. Provider business mailing address

1400 CATRON AVE SE
ALBUQUERQUE NM
87123-4227
US

V. Phone/Fax

Practice location:
  • Phone: 505-448-0203
  • Fax: 505-336-6524
Mailing address:
  • Phone: 505-448-0203
  • Fax: 505-336-6524

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: JOELLEN SCHIMMELS
Title or Position: NURSE PRACTITIONER
Credential: PHD, DNP, PMHNP-BC
Phone: 505-448-0203