Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8200 CENTRAL AVE SE, ALBUQUERQUE, NM 87108-2408
(505) 272-5885
(505) 272-5888
Mailing address
328 MAIN ST NE, LOS LUNAS, NM 87031-7454
(505) 272-3120
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R36062
NM
Other
Enumeration date
11/16/2005
Last updated
07/10/2019
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