Healthcare Provider Details

I. General information

NPI: 1740970516
Provider Name (Legal Business Name): NANCY RUBENDALL LMT, CNMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 CANDELARIA RD NE
ALBUQUERQUE NM
87112-1457
US

IV. Provider business mailing address

2517 GRETTA ST NE
ALBUQUERQUE NM
87112-1626
US

V. Phone/Fax

Practice location:
  • Phone: 702-358-7619
  • Fax:
Mailing address:
  • Phone: 702-358-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4787
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: