Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD2014-0660 | NM |
NPI | 1013234616 |
---|---|
Provider Name | Jessica Mitchell |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2010 |
Last Update Date | 22/03/2017 |