Provider Information for 1841268158
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VIRGINIA C VARY LISW
Sex: Female
NPI: 1841268158
Last Updated: 2012-01-30
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1841268158 | ||||||||||||||||||||
| Enumeration Date | 2006-03-11 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 12541 INDIAN TRAIL NE ALBUQUERQUE, NM 87112-4717 United States Phone: 505-379-7532 | Fax:505-299-1294 | ||||||||||||||||||||
| Primary Practice Address | 1400 CARLISLE BLVD NE SUITE C ALBUQUERQUE, NM 87110-5658 United States Phone: 505-379-7532 | Fax: | ||||||||||||||||||||
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