Provider Demographics
NPI:1932856481
Name:STRACENER, PRISCILLA (LMT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:STRACENER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CAPITOL DR SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8609
Mailing Address - Country:US
Mailing Address - Phone:505-239-9644
Mailing Address - Fax:505-896-2958
Practice Address - Street 1:430 CAPITOL DR SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8609
Practice Address - Country:US
Practice Address - Phone:505-239-9644
Practice Address - Fax:505-896-2958
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8055OtherSTATE OF NM