Healthcare Provider Details

I. General information

NPI: 1083751838
Provider Name (Legal Business Name): RWC REIDS WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 MENAUL BLVD NE SUITE A
ALBUQUERQUE NM
87122-2557
US

IV. Provider business mailing address

11616 SNOWHEIGHTS BLVD NE 12300 MENUAL, NE SUITE A ALBUQUERQUE, NEW MEXICO 87122
ALBUQUERQUE NM
87112-3158
US

V. Phone/Fax

Practice location:
  • Phone: 505-250-7114
  • Fax: 866-256-4155
Mailing address:
  • Phone: 505-250-7114
  • Fax: 866-256-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR07010
License Number StateNM

VIII. Authorized Official

Name: MRS. DINA JENE REID
Title or Position: SOLE PROPRIEOTOR
Credential: CNP EX PHYSIOLOGIST
Phone: 505-250-7114