Individual
MICHELLE C UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4705 MONTGOMERY BLVD NE, SUITE 301, ALBUQUERQUE, NM 87109-1226
(505) 727-4500
(505) 727-4505
Mailing address
6100 PAN AMERICAN EAST FWY NE, SUITE 100, ALBUQUERQUE, NM 87109-3427
(505) 727-6200
(505) 727-9590
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA20040046
NM
363AS0400X
Surgical Physician Assistant
PA20040046
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20837054
—
NM
Enumeration date
07/11/2006
Last updated
08/13/2015
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