Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 558669 | TX |
NPI | 1003004144 |
---|---|
Provider Name | Mrs. Kristell L Michael |
First Address | Albuquerque, NM 87117-5522 |
Second Address | Albuquerque, NM 87117-6027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 09/08/2018 |