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Individual

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Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
119 9TH ST SW, ALBUQUERQUE, NM 87102-3036
(505) 550-5520

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70610
NM

Other

Enumeration date
11/09/2022
Last updated
11/09/2022
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