Healthcare Provider Details

I. General information

NPI: 1801113808
Provider Name (Legal Business Name): MEREDITH LUDDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 SAN MATEO BLVD NE
ALBUQUERQUE NM
87113-2237
US

IV. Provider business mailing address

9521 SAN MATEO BLVD NE
ALBUQUERQUE NM
87113-2237
US

V. Phone/Fax

Practice location:
  • Phone: 505-923-5415
  • Fax:
Mailing address:
  • Phone: 505-923-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0131601
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: