Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | R17232 | NM |
NPI | 1356465694 |
---|---|
Provider Name | Lynda Holliday |
First Address | Santa Fe, NM 87504-0568 |
Second Address | Santa Fe, NM 87501-1692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |