Provider Demographics
NPI:1417780511
Name:PRIMARY CARE OF ALBUQUERQUE LLC
Entity type:Organization
Organization Name:PRIMARY CARE OF ALBUQUERQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WELDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:505-315-5220
Mailing Address - Street 1:7520 MONTGOMERY NE
Mailing Address - Street 2:SUITE D-4 BUILDING D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-315-5220
Mailing Address - Fax:
Practice Address - Street 1:7520 MONTGOMERY NE
Practice Address - Street 2:SUITE D-4 BUILDING D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-315-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty