Individual
LAIVEN JEAN DE CHANTAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1509 UNIVERSITY BLVD NE, ALBUQUERQUE, NM 87102-1708
(505) 231-1650
Mailing address
3136 TAOS MEADOWS DR NE, RIO RANCHO, NM 87144-8587
(505) 231-1650
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
75171
NM
363LF0000X
Family Nurse Practitioner
75171
NM
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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