Healthcare Provider Details

I. General information

NPI: 1750265690
Provider Name (Legal Business Name): TAHNI MAE LAZYBOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PARKWAY DR
SANTA FE NM
87507-7258
US

IV. Provider business mailing address

4600 COLUMBINE AVE NE
ALBUQUERQUE NM
87113-2236
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-7618
  • Fax:
Mailing address:
  • Phone: 505-916-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: