Individual
MISS AN T THAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2411
Mailing address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2023-0297
NM
Other
Enumeration date
07/06/2022
Last updated
10/29/2024
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