Wildflower Wellness of New Mexico, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

WILDFLOWER WELLNESS OF NEW MEXICO, LLC

Practice address

1336 Wyoming Blvd NE
Albuquerque, NM 87112-5066

Phone

(505) 228-7128

NPI assigned

Aug 20, 2024

Last updated

Aug 20, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Josefina Brianna Isaacson, D.O.M.NPI 1710534037

Title

Owner

Phone

(505) 228-7128

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Classical Chinese Medicine New Mexico Former legal business name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Josefina Brianna Isaacson, DOM

  • Acupuncturist
  • Albuquerque, NM
  • NPI 1710534037
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1255164976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 WYOMING BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871125066",
            "telephone_number": "505-228-7128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 WYOMING BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871125066",
            "telephone_number": "505-228-7128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDFLOWER WELLNESS OF NEW MEXICO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "ISAACSON",
        "authorized_official_first_name": "JOSEFINA",
        "authorized_official_middle_name": "BRIANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-228-7128",
        "authorized_official_credential": "D.O.M."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1710534037",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1952181893",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Classical Chinese Medicine New Mexico",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Cassidy Wilder
• Robert L Wilder
• David S Wildes Jr., PHARM.D.
• Wildflower Counseling, LLC
• Wildflower Serenity, LLC (Wildflower Serenity Wellness, LLC)
• Cynthia Wiley
• Leila Wiley
• Naketta Jean Wiley
• Dana M Wilging, PA-C
• Scot Wilging, PA-C

• Acupuncturist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Acupuncturist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.