Provider Demographics
NPI:1114608577
Name:SANGRE DE CRISTO HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SANGRE DE CRISTO HEALTH AND WELLNESS
Other - Org Name:SANGRE DE CRISTO HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:505-718-6319
Mailing Address - Street 1:830 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9405
Mailing Address - Country:US
Mailing Address - Phone:505-718-6319
Mailing Address - Fax:
Practice Address - Street 1:830 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9405
Practice Address - Country:US
Practice Address - Phone:505-718-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care