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1700970597
JAN M. WISTE
ALBUQUERQUE, NM
NPI
1700970597
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207P00000X Emergency Medicine
(Licence: NM 81-344)
Enumeration Date
2006-10-03
Last Update Date
2016-03-24
Business Address
JAN M. WISTE MD
1100 CENTRAL AVE SE PMG EMERGENCY MEDICINE
ALBUQUERQUE, NM 87106-4930
Phone number: 505-841-1125
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Mailing Address
JAN M. WISTE MD
PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE, NM 87125-6666
Phone number: 505-923-6770
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