Provider Demographics
NPI:1740970516
Name:RUBENDALL, NANCY (LMT, CNMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RUBENDALL
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 GRETTA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1626
Mailing Address - Country:US
Mailing Address - Phone:702-358-7619
Mailing Address - Fax:
Practice Address - Street 1:9720 CANDELARIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1457
Practice Address - Country:US
Practice Address - Phone:702-358-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty