Provider Demographics
NPI:1245356070
Name:LIAN, NITYAMO (DOM, MPH)
Entity type:Individual
Prefix:DR
First Name:NITYAMO
Middle Name:
Last Name:LIAN
Suffix:
Gender:F
Credentials:DOM, MPH
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 35863
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5863
Mailing Address - Country:US
Mailing Address - Phone:505-232-7654
Mailing Address - Fax:
Practice Address - Street 1:206 PASEO DEL PUEBLO NORTE
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5902
Practice Address - Country:US
Practice Address - Phone:505-232-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist