MEDICARE: NANULIA

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	261QX0100X	Occupational Medicine Clinic/Center	03-035189-008	NM

General Provider Information

NPI Number	:	1982825667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANULIA

Provider Business Mailing Address
First Line	:	1717 LOUISIANA BLVD NE
Second Line	:	SUITE 212
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4058
Country	:	US
Telephone Number	:	505-881-8785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 LOUISIANA BLVD NE
Second Line	:	SUITE 212
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7001
Country	:	US
Telephone Number	:	505-881-8785
Fax Number	:	505-872-8785

Authorized Official
Title or Position	:	CO-OWNER
Name	:	NANCI BALDWIN
Credential	:	RN
Telephone Number	:	505-881-8785

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	09/23/2010

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Directions to “NANULIA ” Practice Location

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