Provider Demographics
NPI:1356675243
Name:FELDBERG, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:FELDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 CALLE ESPEJO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4902
Mailing Address - Country:US
Mailing Address - Phone:505-438-0010
Mailing Address - Fax:505-438-6011
Practice Address - Street 1:2325 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3373
Practice Address - Country:US
Practice Address - Phone:505-438-0010
Practice Address - Fax:505-438-6011
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator