Provider Demographics
NPI:1740659770
Name:DUFFY, JEANETTE (DOM)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6739 ACADEMY RD NE
Mailing Address - Street 2:SUITE 254
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3351
Mailing Address - Country:US
Mailing Address - Phone:505-903-5698
Mailing Address - Fax:
Practice Address - Street 1:6739 ACADEMY RD NE
Practice Address - Street 2:SUITE 254
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3351
Practice Address - Country:US
Practice Address - Phone:505-903-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1076171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist