Healthcare Provider Details

I. General information

NPI: 1972474070
Provider Name (Legal Business Name): MELORA L LAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5123 MIRADA DR NW
ALBUQUERQUE NM
87120-5736
US

IV. Provider business mailing address

5123 MIRADA DR NW
ALBUQUERQUE NM
87120-5736
US

V. Phone/Fax

Practice location:
  • Phone: 505-270-3316
  • Fax:
Mailing address:
  • Phone: 505-270-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberBRC-2011-320809
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: