Healthcare Provider Details

I. General information

NPI: 1558607549
Provider Name (Legal Business Name): LINDA CHRISTIE DOERING DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N BROADWAY ST
TRUTH OR CONSEQUENCES NM
87901-2834
US

IV. Provider business mailing address

310 N BROADWAY ST
TRUTH OR CONSEQUENCES NM
87901-2834
US

V. Phone/Fax

Practice location:
  • Phone: 505-440-3482
  • Fax:
Mailing address:
  • Phone: 505-440-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number894
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11046558
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: