Organization
DJAA TLHENAI MEDICINE LODGE
Active
Parent organization
LI PA HENNE TRIBE
Organization subpart
Yes
Provider details
NPI number
Legal business name
LI PA HENNE TRIBE
Authorized official
OATZINU SHEELAKEE IAMP (FOUNDER)
(505) 819-3403
Entity
Organization
Contact information
Practice address
111 CARLISLE BLVD SE, ALBUQUERQUE, NM 87106-1427
(505) 819-3403
Mailing address
POB 4682, ALBUQUERQUE, NM 87196
(505) 819-3403
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12-00116271
NM
Other
Enumeration date
11/07/2013
Last updated
11/07/2013
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