Healthcare Provider Details

I. General information

NPI: 1609983543
Provider Name (Legal Business Name): EMILY B CARMANY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 HOMESTEAD RD NE SUITE 201
ALBUQUERQUE NM
87110-1437
US

IV. Provider business mailing address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-4729
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-7724
  • Fax: 505-262-3476
Mailing address:
  • Phone: 505-262-7960
  • Fax: 505-232-1368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number98-PA03
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: