Individual
CHARMIANNE CRONK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3821 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4679
(505) 998-7400
(505) 998-7741
Mailing address
3821 MASTHEAD ST NE, ALBUQUERQUE, NM 87109-4679
(505) 998-7400
(505) 998-7741
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2004-0031
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12075272
—
NM
Enumeration date
05/13/2006
Last updated
08/29/2020
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