Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD2006-0151 | NM |
NPI | 1023054913 |
---|---|
Provider Name | Dr. Lori S. Whitley |
First Address | Los Alamos, NM 87544-2275 |
Second Address | Los Alamos, NM 87544-2275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00636371 | (05) | NM |
I57853 | (02) |