Individual
LAURIE DANIELLE VANDERJAGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 YUCCA ST, SANTA FE, NM 87505-5456
(505) 379-4719
Mailing address
2100 YUCCA ST, SANTA FE, NM 87505-5456
(505) 379-4719
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
10468528
NM
163WS0200X
School Registered Nurse
Primary
R47242
NM
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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