Individual
MRS. MANDI KAY SUSSEX-UPHOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1005 21ST ST SE STE 4, RIO RANCHO, NM 87124-4030
(505) 402-3188
Mailing address
7009 CHRISTY AVE NE, ALBUQUERQUE, NM 87109-3901
(505) 402-3363
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7209
NM
Other
Enumeration date
02/14/2013
Last updated
02/14/2013
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