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General NPI Number Information
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NPI Number | 1861693137
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Entity Type | Individual
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Provider Name | NATHAN A WALES DOM
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1660 OLD PECOS TRL SUITE H
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City | SANTA FE
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State | NM
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Zip | 87505-4779
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Country | US
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Telephone | 505-470-5705
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Fax |
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Provider Business Mailing Address
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Address Line | 2370 CAMINO MELITON APT A
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City | SANTA FE
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State | NM
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Zip | 87507
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Country | US
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Telephone | 505-470-5705
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 926
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License Number State | NM
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