Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 83-242 | NM |
NPI | 1003876160 |
---|---|
Provider Name | Lynn Longfield |
First Address | Albuquerque, NM 87109-3427 |
Second Address | Albuquerque, NM 87114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E52085 | (02) | NM |