Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP-02743 | NM |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | CNP-02743 | NM |
NPI | 1598131773 |
---|---|
Provider Name | My Ha |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-4930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2015 |
Last Update Date | 24/09/2015 |