Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD2019-0742 | NM |
NPI | 1649536228 |
---|---|
Provider Name | Tessa E Krantz |
First Address | Albuquerque, NM 87109-1234 |
Second Address | Albuquerque, NM 87109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2012 |
Last Update Date | 28/10/2019 |