Individual
MR. EDWIN AKWANGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 S SECOND ST STE B, GALLUP, NM 87301-5898
(505) 420-5111
(505) 420-5114
Mailing address
1500 S SECOND ST STE B, GALLUP, NM 87301-5898
(505) 420-5111
(505) 420-5114
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1117773
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
73651
NM
Other
Enumeration date
05/08/2023
Last updated
06/10/2024
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