Healthcare Provider Details

I. General information

NPI: 1447405360
Provider Name (Legal Business Name): MEGAN ELIZABETH LOTT D.O.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 S SAINT FRANCIS DR STE C
SANTA FE NM
87505-4098
US

IV. Provider business mailing address

PO BOX 352
TESUQUE NM
87574-0352
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-2126
  • Fax:
Mailing address:
  • Phone: 505-466-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number970
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: