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NPI Code Detail

MEDICARE: LANI MARIE DESAULNIERS MD

MEDICARE:   LANI MARIE DESAULNIERS  MD
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
1207Q00000XFamily Medicine Physician87-378NM

General Provider Information

NPI Number : 1174510028
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANI MARIE DESAULNIERS MD
Provider Business Mailing Address
First Line : 4809 NORTHRIDGE CT NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-3020
Country : US
Telephone Number : 505-292-6947
Fax Number : 505-248-7697
Provider Business Practice Location Address
First Line : 801 VASSAR DR NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2725
Country : US
Telephone Number : 505-248-4017
Fax Number : 505-248-7697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 02/28/2012

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Directions to “ LANI MARIE DESAULNIERS MD” Practice Location

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