Individual
MARIAN JANE NIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6701 FORTUNA RD NW, WEST MESA HS, ALBUQUERQUE, NM 87121-1306
(505) 831-6903
Mailing address
6701 FORTUNA RD NW, WEST MESA HS, ALBUQUERQUE, NM 87121-1306
(505) 831-6903
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C 4346
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NONE ASSIGNED
—
NM
Enumeration date
08/18/2008
Last updated
08/18/2008
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