Provider Demographics
NPI:1982724530
Name:MADDOUX, BARBARA T (RN, DOM)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:T
Last Name:MADDOUX
Suffix:
Gender:F
Credentials:RN, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 EAGLE SPRINGS DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1258
Mailing Address - Country:US
Mailing Address - Phone:505-292-0903
Mailing Address - Fax:
Practice Address - Street 1:5700 HARPER DR NE STE 470
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3585
Practice Address - Country:US
Practice Address - Phone:505-828-9642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM613RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM01RD7KOtherBCBS PROVIDER NUMBER