Healthcare Provider Details

I. General information

NPI: 1457699357
Provider Name (Legal Business Name): KARRIE J HOPPER D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

PO BOX 718
TESUQUE NM
87574-0718
US

V. Phone/Fax

Practice location:
  • Phone: 505-986-9109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1066
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: