Provider Demographics
NPI:1184227860
Name:MAFFUCCI, LYNNETT KAY (DOM)
Entity Type:Individual
Prefix:
First Name:LYNNETT
Middle Name:KAY
Last Name:MAFFUCCI
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:LYNNETT
Other - Middle Name:KAY
Other - Last Name:KRAUSE-GRIEGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 C DE BACA LN NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-1600
Mailing Address - Country:US
Mailing Address - Phone:505-269-4890
Mailing Address - Fax:
Practice Address - Street 1:1500 LOMAS BLVD NW STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1200
Practice Address - Country:US
Practice Address - Phone:505-503-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist