Provider Information for 1700073129
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Mr. BRUCE KENDRICK LINDSEY LISW
Sex: Male
NPI: 1700073129
Last Updated: 2022-07-29
Certification Date: 2022-07-29
Certification Date: 2022-07-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1700073129 | ||||||||
| Enumeration Date | 2007-09-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 6880 SANTA FE, NM 87502-6880 United States Phone: 505-216-0332 | Fax:505-982-0279 | ||||||||
| Primary Practice Address | 4710 JEFFERSON ST NE STE A ALBUQUERQUE, NM 87109-2156 United States Phone: 505-955-9454 | Fax:505-888-9644 | ||||||||
| Secondary Practice Address(es) | 649 HARKLE RD STE E | ||||||||
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