Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 202635927 | NM |
NPI | 1871820977 |
---|---|
Provider Name | Marcia Allen |
First Address | Albuquerque, NM 87109-1350 |
Second Address | Albuquerque, NM 87109-1350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2009 |
Last Update Date | 10/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05756863 | (05) | NM |
1881667806 | (05) | NM |