Individual
LISA ANNE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 RIO BRAVO BLVD SW STE 36, ALBUQUERQUE, NM 87105-6060
(505) 777-3004
Mailing address
PO BOX 740018, ATLANTA, GA 30374-0018
(773) 759-7550
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
57020
NM
Other
Enumeration date
07/22/2019
Last updated
12/28/2022
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