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General NPI Number Information
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NPI Number | 1700871993
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Entity Type | Organization
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Legal Business Name | LCT INC
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1010 SPRUCE ST
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City | ESPANOLA
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State | NM
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Zip | 87532-3456
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Country | US
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Telephone | 505-753-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 62002 NBU20
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City | ESPANOLA
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State | NM
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Zip | 87532-2711
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Country | US
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Telephone | 505-747-8639
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORI CARMEN
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Credential | CRNA
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Telephone | 505-747-8639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | NM
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