Provider Demographics
NPI:1639294424
Name:LAURSEN, ABBIE L (MD)
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:L
Last Name:LAURSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-747-7396
Practice Address - Street 1:9TH AND WASHINGTON BLDG 356 C
Practice Address - Street 2:CIMARRON HEALTH CARE CLINIC
Practice Address - City:CIMARRON
Practice Address - State:NM
Practice Address - Zip Code:87714
Practice Address - Country:US
Practice Address - Phone:505-376-2402
Practice Address - Fax:505-376-2107
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020324207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47857561Medicaid
NM349418005Medicare PIN
G12491Medicare UPIN