Individual
MARY ANNE DOMRZALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1234
(505) 841-1956
Mailing address
1720 LOUISIANA BLVD NE, SUITE #401, ALBUQUERQUE, NM 87110-7022
(505) 260-4300
(505) 260-4371
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R33166
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202037169
PHP
NM
Enumeration date
02/16/2006
Last updated
08/13/2009
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