Healthcare Provider Details

I. General information

NPI: 1972818367
Provider Name (Legal Business Name): PAMELA SUE BARRETT D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 MONTGOMERY BLVD NE SUITE 206
ALBUQUERQUE NM
87109-1500
US

IV. Provider business mailing address

408 GENERAL STILWELL ST NE
ALBUQUERQUE NM
87123-1028
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-1701
  • Fax:
Mailing address:
  • Phone: 505-850-8576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1028
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: