Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 812 | NM |
NPI | 1033124722 |
---|---|
Provider Name | Dr. Nancy Aeren Grau |
First Address | Albuquerque, NM 87108-3383 |
Second Address | Albuquerque, NM 87108-5547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10070541 | (05) | NM |