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Individual

MR. WALI ABDUSH-SHAKUR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NURSE

Contact information

Practice address
2001 CHAMISA ST, SANTA FE, NM 87505-3441
(505) 982-2129
(505) 992-1149
Mailing address
2001 CHAMISA ST, SANTA FE, NM 87505-3441
(505) 982-2129
(505) 992-1149

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R65082
NM

Other

Enumeration date
08/18/2009
Last updated
08/18/2009
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