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General NPI Number Information
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NPI Number | 1184904054
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Entity Type | Organization
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Legal Business Name | INTEGRATED FAMILY WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 8300 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1703
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Country | US
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Telephone | 505-293-1658
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Fax | 505-298-4737
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Provider Business Mailing Address
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Address Line | 8300 SAN PEDRO DR NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87113-1703
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Country | US
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Telephone | 505-293-1658
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Fax | 505-298-4737
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Authorized Official
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Title or Position | OWNER
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Name | MRS. PHILOMENA E MARCUS
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Credential | CFNP
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Telephone | 505-293-1658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R25188
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License Number State | NM
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