Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 6437 | WI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | RS2020-0512 | NM |
NPI | 1528414646 |
---|---|
Provider Name | Sierra Mariette Jansen |
First Address | Albuquerque, NM 87106-2719 |
Second Address | Albuquerque, NM 87106-2719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2016 |
Last Update Date | 18/06/2020 |