Individual
LORI CARMEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1010 SPRUCE ST, ESPANOLA, NM 87532-3456
(505) 753-7111
Mailing address
1000 CORDOVA PL, # 712, SANTA FE, NM 87505-1725
(505) 747-8639
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R47417
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17104505
—
NM
01
—
430074229
RAILROAD MEDICARE INDIVID
NM
01
—
NM006426
BCB NM - INDIVIDUAL
NM
Enumeration date
09/14/2005
Last updated
02/05/2019
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