Healthcare Provider Details

I. General information

NPI: 1184793283
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF N.M., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

IV. Provider business mailing address

719 SAN MATEO NE
ALBUQUERQUE NM
87108
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-5976
  • Fax: 505-266-1017
Mailing address:
  • Phone: 505-265-5976
  • Fax: 505-266-1017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNY C BLACK
Title or Position: PRESIDENT/CEO
Credential:
Phone: 505-265-5976