Individual
MRS. JESSICA LUCILLA WYACO TSABETSAYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5901 HARPER DR NE, PMG URGENT CARE, ALBUQUERQUE, NM 87109-3587
(505) 823-8233
(505) 823-8059
Mailing address
5712 POTENTILLA CT NW, ALBUQUERQUE, NM 87120-6240
(505) 720-0606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2011-0034
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19778082
—
NM
Enumeration date
09/26/2011
Last updated
02/05/2015
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