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General NPI Number Information
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NPI Number | 1114608577
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Entity Type | Organization
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Legal Business Name | SANGRE DE CRISTO HEALTH AND WELLNESS
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Dates
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Enumeration Date | 07/28/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 830 AIRPORT RD
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City | LAS VEGAS
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State | NM
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Zip | 87701-9405
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Country | US
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Telephone | 505-718-6319
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Fax |
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Provider Business Mailing Address
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Address Line | 830 AIRPORT RD
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City | LAS VEGAS
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State | NM
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Zip | 87701-9405
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Country | US
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Telephone | 505-718-6319
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JENNY NATION
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Credential | FNP-BC
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Telephone | 505-718-6319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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