Individual
MICHAELA MORAN REKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(651) 491-8529
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
(414) 259-1145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PA2021-0073
NM
363A00000X
Physician Assistant
Primary
PA2021-0073
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538711841
—
WI
Enumeration date
07/16/2019
Last updated
10/11/2024
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