Individual
ELISE NICOLE PEDIGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
630 HAINES AVE NW, ALBUQUERQUE, NM 87102-1226
(505) 268-5611
(505) 268-5736
Mailing address
3864 MASTHEAD ST NE UNIT E2, ALBUQUERQUE, NM 87109-4479
(505) 356-4178
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2017-0099
NM
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
10/12/2017
Last updated
08/16/2023
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