Provider Demographics
NPI:1194170605
Name:SIOW, ANNA MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:SIOW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:JARAMILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1014 HUMMINGBIRD PL SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-8130
Mailing Address - Country:US
Mailing Address - Phone:505-582-4246
Mailing Address - Fax:
Practice Address - Street 1:1014 HUMMINGBIRD PL SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-8130
Practice Address - Country:US
Practice Address - Phone:505-582-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2016-0007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44670575Medicaid
NMPA2016-0007OtherPA LICENSE