| Beewell Medical Center | |
|
2900 Louisiana Blvd Ne Ste J1 Albuquerque NM 87110-3575 | |
| (505) 554-8315 | |
| (505) 213-2657 |
| Full Name | Beewell Medical Center |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2900 Louisiana Blvd Ne Ste J1, Albuquerque, New Mexico |
| Authorized Official Name and Position | Kontasha Shamika Wise (CNP, PMHNP-BC) |
| Authorized Official Contact | 5055548315 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beewell Medical Center 8226 Menaul Blvd Ne # 144 Albuquerque NM 87110-4614 Ph: (505) 554-2681 | Beewell Medical Center 2900 Louisiana Blvd Ne Ste J1 Albuquerque NM 87110-3575 Ph: (505) 554-8315 |
| NPI Number | 1033706924 |
|---|---|
| Provider Enumeration Date | 12/25/2020 |
| Last Update Date | 07/26/2024 |
| Medicare PECOS PAC ID | 1557774791 |
|---|---|
| Medicare Enrollment ID | O20210108000509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033706924 | NPI | - | NPPES |
| Provider Name | Kontasha Shamika Wise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679850044 PECOS PAC ID: 5395906960 Enrollment ID: I20171206001432 |
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