Healthcare Provider Details

I. General information

NPI: 1043369499
Provider Name (Legal Business Name): ANNE CAMPBELL DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 DON FERNANDO RD
SANTA FE NM
87505-1629
US

IV. Provider business mailing address

320 DON FERNANDO RD
SANTA FE NM
87505-1629
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-1676
  • Fax:
Mailing address:
  • Phone: 505-216-1676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number874
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: