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General NPI Number Information
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NPI Number | 1417186560
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Entity Type | Individual
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Provider Name | MARIE ELIZABETH MUGAVIN PHD, FNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 5800 MCLEOD RD NE STE D
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-2467
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Country | US
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Telephone | 505-508-1167
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Fax | 505-212-0332
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Provider Business Mailing Address
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Address Line | PO BOX 14888
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City | ALBUQUERQUE
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State | NM
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Zip | 87191-4888
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Country | US
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Telephone | 505-508-1167
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Fax | 505-212-0332
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R39817
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP00879
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License Number State | NM
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