Healthcare Provider Details

I. General information

NPI: 1306011036
Provider Name (Legal Business Name): LAURIE L. ENGLE DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 VISTA GRANDE CIR
SANTA FE NM
87508-8322
US

IV. Provider business mailing address

3 VISTA GRANDE CIR
SANTA FE NM
87508-8322
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-1213
  • Fax: 505-466-1213
Mailing address:
  • Phone: 505-466-1213
  • Fax: 505-466-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number783
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: