Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 53941 | NM |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 53941 | NM |
NPI | 1003387796 |
---|---|
Provider Name | Traci Lee Sailer |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87106-4375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 02/09/2021 |