Healthcare Provider Details

I. General information

NPI: 1104801182
Provider Name (Legal Business Name): STEVE K LAUER FNP C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TIJERAS AVE NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

1020 TIJERAS AVE NE
ALBUQUERQUE NM
87106-4749
US

V. Phone/Fax

Practice location:
  • Phone: 505-848-3124
  • Fax: 505-848-5008
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNP01184
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: