Healthcare Provider Details

I. General information

NPI: 1427246479
Provider Name (Legal Business Name): RUTH LYNNE HULETT D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST SUITE 207
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

1704 LLANO ST # 227
SANTA FE NM
87505-5415
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-0128
  • Fax:
Mailing address:
  • Phone: 505-310-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number816
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: