Provider Demographics
NPI:1306011036
Name:ENGLE, LAURIE L (DOM)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:L
Last Name:ENGLE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 VISTA GRANDE CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8322
Mailing Address - Country:US
Mailing Address - Phone:505-466-1213
Mailing Address - Fax:505-466-1213
Practice Address - Street 1:3 VISTA GRANDE CIR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8322
Practice Address - Country:US
Practice Address - Phone:505-466-1213
Practice Address - Fax:505-466-1213
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM783171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist