Organization
JESSICA PROCHNOW, RNFA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAM WORTH (BILLING MANAGER)
(214) 227-2457
Entity
Organization
Contact information
Practice address
2903 HYDER AVE SE, ALBUQUERQUE, NM 87106-2938
(214) 227-2457
(972) 463-7247
Mailing address
2903 HYDER AVE SE, ALBUQUERQUE, NM 87106-2938
(214) 227-2457
(972) 463-7247
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
R49466
NM
Other
Enumeration date
09/24/2012
Last updated
09/24/2012
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