Individual
MARA SWARTZENTRUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
PO BOX 26666, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0096
NM
363A00000X
Physician Assistant
PA8582
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110183644A
—
MA
05
—
3137331
—
NH
Enumeration date
10/13/2020
Last updated
10/11/2024
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