Individual
STACEY RENEE VIERRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5522
(505) 846-3200
(406) 731-2691
Mailing address
2050A 2ND ST SE, KIRTLAND AFB, NM 87117-5522
(505) 846-3200
(406) 731-2691
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/05/2009
Last updated
03/31/2021
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