Individual
WILLIAM WACKOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2720 SAN PEDRO DR NE, ALBUQUERQUE, NM 87110-3333
(505) 265-7936
(505) 265-9685
Mailing address
2720 SAN PEDRO DR NE, ALBUQUERQUE, NM 87110-3333
(505) 265-7936
(505) 265-9685
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
D3124
—
NM
Enumeration date
03/12/2010
Last updated
03/12/2010
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