Individual
MARY E BACEVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Mailing address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1125
(505) 841-1737
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209001262
IL
Other
Enumeration date
05/01/2007
Last updated
11/30/2011
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