Individual
MRS. WABANANG GAIASHKIBOS KUCZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPH, PA-C
Contact information
Practice address
1600 SAINT MICHAELS DR, SANTA FE, NM 87505-7615
(505) 473-6918
(505) 473-6467
Mailing address
16 CLOUD MARCH E, SANTA FE, NM 87506-2171
(505) 989-1893
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2003-0044
NM
Other
Enumeration date
07/17/2006
Last updated
07/08/2007
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