Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2815 | NM |
NPI | 1023129632 |
---|---|
Provider Name | Sandra Lee Hussey |
First Address | Rio Rancho, NM 87144-5160 |
Second Address | Albuquerque, NM 87110-8900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 06/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92071 | PRESBYTERIAN HEALTH PLAN (01) | NM |
RD098 | BCBS BLUE CROSS BLUE SHIE (01) | NM |