Individual
MARY LORING DAGGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
BIKINI ATOLL ROAD MS D421, LOS ALAMOS, NM 87545
(505) 665-2631
Mailing address
2305 CALLE PINTURA, SANTA FE, NM 87505-5273
(505) 471-2569
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
95-PA30
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
K3602
—
NM
Enumeration date
03/28/2007
Last updated
07/09/2007
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