Healthcare Provider Details

I. General information

NPI: 1902663792
Provider Name (Legal Business Name): MIRANDA BUDAGHER-MARSHALL DN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MCLEOD RD NE STE A
ALBUQUERQUE NM
87109-2467
US

IV. Provider business mailing address

5905 WOODFORD DR NE
ALBUQUERQUE NM
87110-1225
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-8322
  • Fax:
Mailing address:
  • Phone: 505-264-8395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License NumberDN2024-0004
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: