Healthcare Provider Details

I. General information

NPI: 1346472578
Provider Name (Legal Business Name): MARGIE J WESLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2009
Last Update Date: 08/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-8952
US

IV. Provider business mailing address

558 APACHE CT SW
RIO RANCHO NM
87124-4285
US

V. Phone/Fax

Practice location:
  • Phone: 505-503-0308
  • Fax:
Mailing address:
  • Phone: 505-503-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number997
License Number StateNM

VIII. Authorized Official

Name: MARGIE J WESLEY
Title or Position: OWNER/OPERATOR
Credential: DOM
Phone: 505-503-0308