Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 53274 | NM |
NPI | 1003313008 |
---|---|
Provider Name | Mrs. Jessika Junick |
First Address | Albuquerque, NM 87111-3559 |
Second Address | Albuquerque, NM 87111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2018 |
Last Update Date | 06/09/2018 |