MEDICARE: MS. LAURIE JAYNE SPIEGEL CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	R22677	NM

General Provider Information

NPI Number	:	1003944471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE JAYNE SPIEGEL CNP

Provider Business Mailing Address
First Line	:	30 LUCERO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-8845
Country	:	US
Telephone Number	:	505-476-2624
Fax Number	:

Provider Business Practice Location Address
First Line	:	605 LETRADO ST
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4146
Country	:	US
Telephone Number	:	505-476-2624
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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