Provider Demographics
NPI:1205484433
Name:DESORMEAU, NADINE (LAC)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:DESORMEAU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 CAMINO VIS NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1917
Mailing Address - Country:US
Mailing Address - Phone:505-907-9334
Mailing Address - Fax:
Practice Address - Street 1:5137 CAMINO VIS NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1917
Practice Address - Country:US
Practice Address - Phone:505-907-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002491171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist