| Olive Tree Wellness LLC | |
|
1713 Wellspring Ave Se Rio Rancho NM 87124-5106 | |
| (505) 738-3328 | |
| Not Available |
| Full Name | Olive Tree Wellness LLC |
|---|---|
| Speciality | Pharmacy |
| Location | 1713 Wellspring Ave Se, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Ndidiamaka Okpareke (OWNER) |
| Authorized Official Contact | 5057383328 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Tree Wellness LLC 1713 Wellspring Ave Se Rio Rancho NM 87124-5106 | Olive Tree Wellness LLC 1713 Wellspring Ave Se Rio Rancho NM 87124-5106 Ph: (505) 738-3328 |
| NPI Number | 1588402580 |
|---|---|
| Provider Enumeration Date | 07/16/2024 |
| Last Update Date | 05/30/2025 |
| Certification Date | 05/30/2025 |
| Medicare PECOS PAC ID | 0648719930 |
|---|---|
| Medicare Enrollment ID | O20240830001012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588402580 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Secondary |
| 3336C0003X | Pharmacy - Community/retail Pharmacy | () | Primary |
| 3336C0004X | Pharmacy - Compounding Pharmacy | () | Secondary |
| Provider Name | Hanna Gasper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285226753 PECOS PAC ID: 9638586894 Enrollment ID: I20210406000851 |
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