Healthcare Provider Details

I. General information

NPI: 1083560643
Provider Name (Legal Business Name): IFEOMA ANTHONIA MEKWUNYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 ACEQUIA BORRADA
SANTA FE NM
87507-3071
US

IV. Provider business mailing address

1326 ACEQUIA BORRADA
SANTA FE NM
87507-3071
US

V. Phone/Fax

Practice location:
  • Phone: 505-204-5533
  • Fax:
Mailing address:
  • Phone: 505-204-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number67502
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: