Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD2006-0418 | NM |
Y | 111NI0900X | Internist | MD2006-0418 | NM |
N | 207RI0200X | Infectious Disease | 2006-0418 | NM |
NPI | 1063508711 |
---|---|
Provider Name | Michelle J. Iandiorio |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207R00000X | (02) | NM |