Healthcare Provider Details

I. General information

NPI: 1952395394
Provider Name (Legal Business Name): FIQUET HANNA DUCKWORTH DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S SAINT FRANCIS DR
SANTA FE NM
87505-4040
US

IV. Provider business mailing address

PO BOX 24229
SANTA FE NM
87502-9229
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-9626
  • Fax: 505-983-2320
Mailing address:
  • Phone: 505-982-9626
  • Fax: 505-983-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number119RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: