Healthcare Provider Details

I. General information

NPI: 1194366393
Provider Name (Legal Business Name): MRS. KAMI LEA DONALD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 WILDFLOWER DR
FARMINGTON NM
87401-2846
US

IV. Provider business mailing address

4704 EASTWIND AVE
FARMINGTON NM
87401-8602
US

V. Phone/Fax

Practice location:
  • Phone: 505-599-8622
  • Fax:
Mailing address:
  • Phone: 505-947-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberB-10893
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: