Provider Demographics
NPI:1417773573
Name:JOHN, ABRIANNE DANELLE
Entity type:Individual
Prefix:
First Name:ABRIANNE
Middle Name:DANELLE
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13509 COPPER AVE NE APT 3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1746
Mailing Address - Country:US
Mailing Address - Phone:661-699-4469
Mailing Address - Fax:
Practice Address - Street 1:500 4TH ST NW STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2104
Practice Address - Country:US
Practice Address - Phone:505-356-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician