Provider Demographics
NPI:1184856981
Name:ANDERSON, KARLENE CELESTE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:KARLENE
Middle Name:CELESTE
Last Name:ANDERSON
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 1:5240 ZURICH PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5713
Mailing Address - Country:US
Mailing Address - Phone:505-917-5893
Mailing Address - Fax:
Practice Address - Street 1:5240 ZURICH PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5713
Practice Address - Country:US
Practice Address - Phone:505-917-5893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4117174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist