Provider Demographics
NPI:1760652341
Name:DILLINGHAM, LAUREL ANN (RN)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:DILLINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 80810
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87198-0810
Mailing Address - Country:US
Mailing Address - Phone:505-841-8978
Mailing Address - Fax:505-841-8977
Practice Address - Street 1:5901 ZUNI RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3073
Practice Address - Country:US
Practice Address - Phone:505-841-8978
Practice Address - Fax:505-841-8977
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR25588163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR25588OtherRN