Organization
REVITALIZED NATURAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHILOMENA E MARCUS CFNP (OWNER)
(505) 293-1658
Entity
Organization
Contact information
Practice address
720 LAMP POST CIR SE, ALBUQUERQUE, NM 87123-4115
(505) 293-1658
(505) 298-4737
Mailing address
720 LAMP POST CIR SE, ALBUQUERQUE, NM 87123-4115
(505) 293-1658
(505) 298-4737
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R25188
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
94108897
—
NM
01
—
NM00RH90
BCBS OF NM
NM
Enumeration date
12/21/2010
Last updated
03/25/2016
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