Healthcare Provider Details

I. General information

NPI: 1720834583
Provider Name (Legal Business Name): DEBORAH LADUKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21124 US HIGHWAY 84
ABIQUIU NM
87510-5503
US

IV. Provider business mailing address

PO BOX 757
ABIQUIU NM
87510-0757
US

V. Phone/Fax

Practice location:
  • Phone: 505-685-4479
  • Fax: 505-685-4532
Mailing address:
  • Phone: 505-685-4479
  • Fax: 505-685-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73640
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: