Individual
NIKI MANOLE NINOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3901 CARLISLE BLVD NE, ALBUQUERQUE, NM 87107-4503
(505) 254-6100
(505) 546-5322
Mailing address
4501 LARCHMONT DR NE, ALBUQUERQUE, NM 87111-3042
(505) 315-6932
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA2018-0074
NM
363AM0700X
Medical Physician Assistant
Primary
PA2018-0074
NM
363AM0700X
Medical Physician Assistant
—
NM
Other
Enumeration date
09/27/2018
Last updated
12/17/2018
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