Provider Demographics
NPI:1033399209
Name:DENNARD, VIVIAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:DENNARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 CARLISLE BLVD NE STE 103
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-2849
Mailing Address - Country:US
Mailing Address - Phone:5059-740-2413
Mailing Address - Fax:
Practice Address - Street 1:2917 CARLISLE BLVD NE STE 103
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-2849
Practice Address - Country:US
Practice Address - Phone:505-974-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8387225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist