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General NPI Number Information
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NPI Number | 1427726652
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Entity Type | Organization
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Legal Business Name | GATEWAY PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 12/27/2024
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Provider Practice Location Address
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Address Line | 1330 SAN PEDRO DR NE STE 205F
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6749
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Country | US
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Telephone | 240-413-0936
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 SAN PEDRO DR NE STE 205F
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6749
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Country | US
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Telephone | 240-413-0936
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMMANUEL KPWE NJI
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Credential |
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Telephone | 240-413-0936
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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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