Doctor Name: | MRS. MANDI KAY SUSSEX-UPHOLD |
NPI Number: | 1518207364 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | 7209 |
Business Practice Address: | 1005 21st St Se Ste 4 Rio Rancho, NM - 871244030 |
Business Phone Number: | 5054023188 |
Business Fax Number: | |
Mailing Address: | 7009 Christy Ave Ne, ALBUQUERQUE |
State: | NM |
Postal Code: | 871093901 |
Phone Number: | 5054023363 |
Fax Number: | |
NPI Enumeration Date: | 02/14/2013 |
NPI Last Update Date: | 02/14/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 7209 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |