Individual
DR. JACQUELYN BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1 UNIVERSITY OF NEW MEXICO, MSC 10-6000, ALBUQUERQUE, NM 87131-0001
(505) 272-6487
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-3120
(505) 272-8060
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
DO2021-0049
NM
390200000X
Student in an Organized Health Care Education/Training Program
R02-2014
NM
Other
Enumeration date
03/31/2014
Last updated
01/04/2022
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