Provider Demographics
NPI:1013994961
Name:WILLINGHURST, LORI (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:WILLINGHURST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4810 HARDWARE DR NE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2013
Mailing Address - Country:US
Mailing Address - Phone:505-401-2527
Mailing Address - Fax:505-255-4717
Practice Address - Street 1:4810 HARDWARE DR NE
Practice Address - Street 2:SUITE 5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2013
Practice Address - Country:US
Practice Address - Phone:505-401-2527
Practice Address - Fax:505-255-4717
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM981992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry