Individual
LINDA LUCY BOULANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1700 CERRILLOS RD, SANTA FE, NM 87505-3554
(505) 988-9821
Mailing address
1522 CERRO GORDO RD, SANTA FE, NM 87501-6143
(505) 982-9002
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
98-18
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71203
—
NM
Enumeration date
09/28/2006
Last updated
03/05/2008
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