Provider Demographics
NPI:1598580425
Name:ITHRIVE INFUSION AND WELLNESS LLC
Entity type:Organization
Organization Name:ITHRIVE INFUSION AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYANG
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:505-926-2999
Mailing Address - Street 1:4611 GREENE ST NW STE 311
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4284
Mailing Address - Country:US
Mailing Address - Phone:505-926-2999
Mailing Address - Fax:505-485-0610
Practice Address - Street 1:4611 GREENE ST NW STE 311
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4284
Practice Address - Country:US
Practice Address - Phone:505-926-2999
Practice Address - Fax:505-485-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty