Individual
DR. LAUREN ELYSE WALTERSDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1035 ALTO ST, SANTA FE, NM 87501-2406
(505) 982-4425
(505) 982-8440
Mailing address
1218 EUCLID ST NW, WASHINGTON, DC 20009-5330
(248) 709-1071
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2015-0076
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12435287
—
NM
Enumeration date
04/05/2012
Last updated
07/21/2022
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