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Organization

TWILIGHT PHYSICIAN GROUP

Active
Parent organization
THE WILLOW FOUNDATION INC.
Organization subpart
Yes

Provider details

NPI number
Legal business name
THE WILLOW FOUNDATION INC.
Authorized official
DENISE IRWIN-PODLESNY RN (FOUNDER)
(505) 512-1880
Entity
Organization

Contact information

Practice address
4273 MONTGOMERY BLVD NE STE 110, ALBUQUERQUE, NM 87109-6746
(505) 512-1880
(866) 502-2372
Mailing address
4273 MONTGOMERY BLVD NE STE 110, ALBUQUERQUE, NM 87109-6746
(505) 512-1880
(866) 502-2372

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
207QG0300X
Geriatric Medicine (Family Medicine) Physician
261QP2300X
Primary Care Clinic/Center
261QR1300X
Rural Health Clinic/Center

Other

Enumeration date
02/13/2023
Last updated
01/29/2024
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