Healthcare Provider Details

I. General information

NPI: 1558558684
Provider Name (Legal Business Name): MARY LINDGREN DISHONGH D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GINGER DISHONGH D.O.M.

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 ENCINO PL NE SUITE B-3
ALBUQUERQUE NM
87102-2612
US

IV. Provider business mailing address

801 ENCINO PL NE SUITE B-3
ALBUQUERQUE NM
87102-2612
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-1118
  • Fax:
Mailing address:
  • Phone: 505-688-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number658
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: