Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 2008014000 | MO |
N | 207U00000X | Nuclear Medicine Specialist | MD2008-0801 | NM |
NPI | 1790824720 |
---|---|
Provider Name | Dr. Joanna Fair |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 11/05/2012 |