Provider Demographics
NPI:1750716296
Name:SCHILLKE, LAUREL E (DOM)
Entity type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:E
Last Name:SCHILLKE
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 1:1217 COAL AVE. SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-5242
Mailing Address - Country:US
Mailing Address - Phone:505-883-5389
Mailing Address - Fax:
Practice Address - Street 1:457 WASHINGTON SE
Practice Address - Street 2:SUITE O
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-883-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM376171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist