Organization
SIB WELLNESS SOLUTIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL BASIAKA ITIE PMHNP-BC (CEO/PROVIDER)
(248) 707-9554
Entity
Organization
Contact information
Practice address
2105 N WASHINGTON AVE, ROSWELL, NM 88201-3369
(248) 707-9554
Mailing address
2105 N WASHINGTON AVE, ROSWELL, NM 88201-3369
(248) 707-9554
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/20/2025
Last updated
04/29/2025
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