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1598315772
PHILLIP MA
ALBUQUERQUE, NM
NPI
1598315772
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: NM 57390)
Enumeration Date
2019-09-18
Last Update Date
2022-10-09
Business Address
PHILLIP MA
8100 CONSTITUTION PL NE
ALBUQUERQUE, NM 87110-7643
Phone number: 505-559-1000
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Mailing Address
PHILLIP MA
6908 WILDWOOD LN NE
ALBUQUERQUE, NM 87111-1073
Phone number: 505-550-7134
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