Individual
MISS SARA MARIE GRECO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106
(505) 724-6124
(505) 724-6125
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2024-0059
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
07/27/2022
Last updated
06/20/2024
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