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General NPI Number Information
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NPI Number | 1992324149
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Entity Type | Organization
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Legal Business Name | WELL LIFE ABQ, LLC
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 8400 OSUNA RD NE STE 5C
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-2072
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Country | US
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Telephone | 505-585-2345
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Fax | 505-800-5030
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Provider Business Mailing Address
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Address Line | 5901J WYOMING BLVD NE # 351
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3866
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Country | US
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Telephone | 505-585-2345
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Fax | 505-800-5030
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE DEVINE
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Credential | APRN
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Telephone | 505-585-2345
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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 |
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License Number State |
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