Healthcare Provider Details

I. General information

NPI: 1245861541
Provider Name (Legal Business Name): WENDY SPRING ROBBINS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4905
US

IV. Provider business mailing address

1821 CARLISLE BLVD NE
ALBUQUERQUE NM
87110-4905
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1228
  • Fax: 505-255-1394
Mailing address:
  • Phone: 505-255-1228
  • Fax: 505-255-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2021-0065
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: