Healthcare Provider Details

I. General information

NPI: 1710743513
Provider Name (Legal Business Name): CHRISTOPHER WESSELMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE # 304
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax:
Mailing address:
  • Phone: 505-688-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number77898
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: