Healthcare Provider Details

I. General information

NPI: 1265998314
Provider Name (Legal Business Name): STILLWATER WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR STE 1205
SANTA FE NM
87505-8605
US

IV. Provider business mailing address

460 SAINT MICHAELS DR STE 1205
SANTA FE NM
87505-8605
US

V. Phone/Fax

Practice location:
  • Phone: 505-920-4867
  • Fax:
Mailing address:
  • Phone: 505-490-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET HOLLEY
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 505-490-6160