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General NPI Number Information
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NPI Number | 1174343933
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Entity Type | Organization
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Legal Business Name | WYCO-CARE, APRN, NURSING CORPORATION
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 1604 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6723
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Country | US
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Telephone | 505-658-8898
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Fax | 505-499-4988
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Provider Business Mailing Address
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Address Line | 1209 MOUNTAIN ROAD PL NE # 8085
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICK WYCOCO
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Credential | NP
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Telephone | 505-658-8898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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