Healthcare Provider Details

I. General information

NPI: 1629228507
Provider Name (Legal Business Name): MS. MARCIA ANN SAHMAUNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE ROAD
DULCE NM
87528
US

IV. Provider business mailing address

P O BOX 187 12000
DULCE NM
87528-0187
US

V. Phone/Fax

Practice location:
  • Phone: 575-759-7246
  • Fax: 575-759-7294
Mailing address:
  • Phone: 505-759-7246
  • Fax: 505-759-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: