Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 86147 | NM |
NPI | 1043304439 |
---|---|
Provider Name | Krista M Wills |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-4925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37440 | (05) | NM |