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General NPI Number Information
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NPI Number | 1629245543
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Entity Type | Organization
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Legal Business Name | WALSH WELLNESS LLC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 4101 N PRINCE ST
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City | CLOVIS
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State | NM
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Zip | 88101-9707
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Country | US
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Telephone | 575-935-3488
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 N PRINCE ST
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City | CLOVIS
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State | NM
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Zip | 88101-9707
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Country | US
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Telephone | 575-935-3488
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Fax |
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Authorized Official
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Title or Position | BILLING CLERK
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Name | MR. RUSSELL DARIN SPICHER
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Credential |
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Telephone | 806-771-1166
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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 | R28624
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License Number State | NM
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