Individual
FAITH OMAMOGHO IGBERAESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 JEFFERSON ST NE, ALBUQUERQUE, NM 87109-4318
(505) 727-6200
Mailing address
4101 INDIAN SCHOOL RD NE STE 110, ALBUQUERQUE, NM 87110-3991
(505) 727-7007
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
RN.0182083
CO
207Q00000X
Family Medicine Physician
APN.1000499-NP
CO
207QG0300X
Geriatric Medicine (Family Medicine) Physician
APN.1000499-NP
CO
363LF0000X
Family Nurse Practitioner
Primary
83157
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83157
STATE LICENSE
NM
Enumeration date
02/18/2025
Last updated
05/21/2025
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