Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD2011-0829 | NM |
NPI | 1003975699 |
---|---|
Provider Name | Diane M. Reisinger |
First Address | Placitas, NM 87043-0604 |
Second Address | Santa Fe, NM 87505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 04/04/2019 |