Individual
MIQUELA CELISSE WIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 CEDAR ST SE STE 7600, ALBUQUERQUE, NM 87106-4921
(505) 563-2500
(505) 563-2599
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2022-0010
NM
363A00000X
Physician Assistant
—
—
Other
Enumeration date
09/17/2020
Last updated
05/26/2022
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