Healthcare Provider Details

I. General information

NPI: 1255342218
Provider Name (Legal Business Name): DONNA LYNN ROLLAND-LOVATO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 EUBANK BLVD NE STE. A3
ALBUQUERQUE NM
87123-2759
US

IV. Provider business mailing address

5301 PURCELL DR NE
ALBUQUERQUE NM
87111-1920
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-8237
  • Fax: 505-881-5207
Mailing address:
  • Phone: 505-688-8237
  • Fax: 505-881-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: