Individual
MANDA LOREE SLOAN-VAN BIBBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Mailing address
1501 SAN PEDRO DR SE, ALBUQUERQUE, NM 87108-5153
(505) 265-1711
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
572
CO
363AM0700X
Medical Physician Assistant
Primary
95-PA-15
NM
Other
Enumeration date
10/18/2005
Last updated
07/10/2021
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