MEDICARE: ITHRIVE INFUSION AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1598580425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITHRIVE INFUSION AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	4611 GREENE ST NW STE 311
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4284
Country	:	US
Telephone Number	:	505-926-2999
Fax Number	:	505-485-0610

Provider Business Practice Location Address
First Line	:	4611 GREENE ST NW STE 311
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4284
Country	:	US
Telephone Number	:	505-926-2999
Fax Number	:	505-485-0610

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	RUTH L NYANG
Credential	:	FNP-C
Telephone Number	:	505-926-2999

Provider Enumeration Date	:	11/16/2024
Last Update Date	:	06/16/2026

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