Provider Demographics
NPI:1174510028
Name:DESAULNIERS, LANI MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:MARIE
Last Name:DESAULNIERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4809 NORTHRIDGE CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3020
Mailing Address - Country:US
Mailing Address - Phone:505-292-6947
Mailing Address - Fax:505-248-7697
Practice Address - Street 1:801 VASSAR DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2725
Practice Address - Country:US
Practice Address - Phone:505-248-4017
Practice Address - Fax:505-248-7697
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2012-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM87-378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50337Medicare ID - Type Unspecified