Healthcare Provider Details

I. General information

NPI: 1396803953
Provider Name (Legal Business Name): LORI BIERI LANGE MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 TRUMAN ST NE
ALBUQUERQUE NM
87108-1333
US

IV. Provider business mailing address

4700 GUADALUPE TRL NW
ALBUQUERQUE NM
87107-3300
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-9506
  • Fax:
Mailing address:
  • Phone: 505-345-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number437
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: