Individual
PHILLIP MA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8100 CONSTITUTION PL NE, ALBUQUERQUE, NM 87110-7643
(505) 559-1000
Mailing address
6908 WILDWOOD LN NE, ALBUQUERQUE, NM 87111-1073
(505) 550-7134
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
57390
NM
Other
Enumeration date
09/18/2019
Last updated
10/09/2022
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