Selenite Health and Wellness LLC

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

Legal business name

SELENITE HEALTH AND WELLNESS LLC

Practice address

4300 Ridgecrest Dr SE
Rio Rancho, NM 87124-5907

Phone

(505) 225-1975

NPI assigned

Dec 28, 2022

Last updated

Dec 28, 2022By 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

Abigail Banmbuh, PMHNPNPI 1508400607

Title

Ceo

Phone

(505) 225-1975

Specialties & licenses 2

Addresses

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.

• Abigail Banmbuh, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Bozeman, MT
  • NPI 1508400607
  NPD Authorized official

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

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672185600000",
    "number": "1447963152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1199 MIRADOR LOOP NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871445324",
            "telephone_number": "281-682-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 RIDGECREST DR SE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871245907",
            "telephone_number": "505-225-1975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELENITE HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-28",
        "last_updated": "2022-12-28",
        "certification_date": "2022-12-28",
        "status": "A",
        "authorized_official_last_name": "BANMBUH",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-225-1975",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction Medicine (Psychiatry & Neurology) Physician in Rio Rancho, NM
• Providers in Rio Rancho, NM by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; 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.