Healthcare Provider Details

I. General information

NPI: 1982724530
Provider Name (Legal Business Name): BARBARA T. MADDOUX RN, DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE STE 470
ALBUQUERQUE NM
87109-3585
US

IV. Provider business mailing address

8747 EAGLE SPRINGS DR NE
ALBUQUERQUE NM
87113-1258
US

V. Phone/Fax

Practice location:
  • Phone: 505-828-9642
  • Fax:
Mailing address:
  • Phone: 505-292-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number613RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: