Healthcare Provider Details

I. General information

NPI: 1336120245
Provider Name (Legal Business Name): MRS. MARIAN MARGARET MESOJEDIC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE NE
ALBUQUERQUE NM
87151-0001
US

IV. Provider business mailing address

1020 MILDRED AVE NW
ALBUQUERQUE NM
87107-2461
US

V. Phone/Fax

Practice location:
  • Phone: 505-839-8839
  • Fax: 505-839-8989
Mailing address:
  • Phone: 505-345-9375
  • Fax: 505-839-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR12655
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: