Provider Demographics
NPI:1932328218
Name:ANDERSON, KAREN TERESA (LMT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:TERESA
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 1:2 N CHAMISA DR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9483
Mailing Address - Country:US
Mailing Address - Phone:505-577-2480
Mailing Address - Fax:505-466-1500
Practice Address - Street 1:2 N CHAMISA DR STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9483
Practice Address - Country:US
Practice Address - Phone:505-577-2480
Practice Address - Fax:505-466-1500
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist