Healthcare Provider Details

I. General information

NPI: 1063077907
Provider Name (Legal Business Name): MELANIE MARYLIN MCBRIDE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HORIZON BLVD NE
ALBUQUERQUE NM
87113-1689
US

IV. Provider business mailing address

8226 MENAUL BLVD NE # 610
ALBUQUERQUE NM
87110-4614
US

V. Phone/Fax

Practice location:
  • Phone: 505-998-1551
  • Fax:
Mailing address:
  • Phone: 505-413-3719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2026-0080
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: