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Individual

STACI A LOGUE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
601 DR MARTIN LUTHER KING JR AVE NE, ALBUQUERQUE, NM 87102-3619
(505) 727-8000
Mailing address
933 BRADBURY DR SE, SUITE 2222, ALBUQUERQUE, NM 87106-4374
(505) 272-2345

Taxonomy

Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
PA2003-0020
NM
2080N0001X
Neonatal-Perinatal Medicine Physician
PA2003-0020
NM

Other

Enumeration date
08/01/2006
Last updated
03/14/2025
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