Individual
MARIANNA ANTONINA MAURELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2211 LOMAS BLVD NE, ALBUQUERQUE, NM 87106-2719
(505) 272-2111
Mailing address
12200 MONTGOMERY BLVD NE APT B104, ALBUQUERQUE, NM 87111-4101
(970) 699-8257
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2022-0080
NM
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
06/05/2020
Last updated
07/16/2024
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