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General NPI Number Information
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NPI Number | 1316742760
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Entity Type | Individual
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Provider Name | FAITH OMAMOGHO IGBERAESE
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Gender | Female
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 6701 JEFFERSON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4318
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Country | US
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Telephone | 505-727-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 INDIAN SCHOOL RD NE STE 110
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3991
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Country | US
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Telephone | 505-727-7007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN.0182083
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | APN.1000499-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | APN.1000499-NP
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 83157
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License Number State | NM
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