Individual
LORI A. WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
510 N GUADALUPE ST, SUITE C1-C2, SANTA FE, NM 87501-6510
(505) 913-4660
Mailing address
440 SAINT MICHAELS DR, SANTA FE, NM 87505-7602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00033275
WA
207Q00000X
Family Medicine Physician
Primary
MD2013-0611
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1097161
—
WA
Enumeration date
10/26/2006
Last updated
01/29/2015
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