Individual
WYATTE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 LOUISIANA BLVD NE STE 410, ALBUQUERQUE, NM 87110-5412
(505) 724-4300
Mailing address
1221 PRINCETON DR NE, ALBUQUERQUE, NM 87106-2616
(505) 310-2434
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2023-0298
NM
Other
Enumeration date
06/24/2022
Last updated
02/20/2024
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