Healthcare Provider Details

I. General information

NPI: 1386309474
Provider Name (Legal Business Name): LINDA RICARDA WOLFLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N RENAISSANCE BLVD NE STE C
ALBUQUERQUE NM
87107-7002
US

IV. Provider business mailing address

1500 N RENAISSANCE BLVD NE STE C
ALBUQUERQUE NM
87107-7002
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-5565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3262076
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: