Individual
ANGELA TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2600 MARBLE AVE NE, ALBUQUERQUE, NM 87106-2058
(505) 272-0409
Mailing address
3406 OLDENBURG CT NE, RIO RANCHO, NM 87144-6515
(505) 918-0090
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
69797
NM
Other
Enumeration date
06/25/2015
Last updated
06/25/2015
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