Healthcare Provider Details

I. General information

NPI: 1396766531
Provider Name (Legal Business Name): SIRKKA-LIISA SPENCER CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3RD AMBULATORY CARE CTR 2211 LOMAS BLVD. NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2211 LOMAS BLVD NE MSC10 5590
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-5551
  • Fax:
Mailing address:
  • Phone: 505-272-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberR49455
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: