Provider Demographics
NPI:1083751838
Name:RWC REIDS WELLNESS CLINIC
Entity type:Organization
Organization Name:RWC REIDS WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIEOTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DINA
Authorized Official - Middle Name:JENE
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:CNP EX PHYSIOLOGIST
Authorized Official - Phone:505-250-7114
Mailing Address - Street 1:11616 SNOWHEIGHTS BLVD NE
Mailing Address - Street 2:12300 MENUAL, NE SUITE A ALBUQUERQUE, NEW MEXICO 87122
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3158
Mailing Address - Country:US
Mailing Address - Phone:505-250-7114
Mailing Address - Fax:866-256-4155
Practice Address - Street 1:12300 MENAUL BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2557
Practice Address - Country:US
Practice Address - Phone:505-250-7114
Practice Address - Fax:866-256-4155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR07010363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4361044OtherLLC