Healthcare Provider Details

I. General information

NPI: 1184786725
Provider Name (Legal Business Name): LORI LYNN WORKIZER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

IV. Provider business mailing address

5015 PROSPECT AVE NE
ALBUQUERQUE NM
87110-4045
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-0036
  • Fax: 505-764-0446
Mailing address:
  • Phone: 505-764-0096
  • Fax: 505-764-0446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2659
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2659
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: