Healthcare Provider Details

I. General information

NPI: 1750716296
Provider Name (Legal Business Name): LAUREL E SCHILLKE DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 WASHINGTON SE SUITE O
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

1217 COAL AVE. SE
ALBUQUERQUE NM
87106-5242
US

V. Phone/Fax

Practice location:
  • Phone: 505-883-5389
  • Fax:
Mailing address:
  • Phone: 505-883-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number376
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: