Individual
JACQUELYN LOUISE LARDIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2420 W. PIERCE ST, STE. 103, CARLSBAD, NM 88220
(575) 628-5051
(575) 628-0493
Mailing address
612 N. MAPLE STREET, CARLSBAD, NM 88220
(575) 628-0927
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704242886
MI
363LF0000X
Family Nurse Practitioner
Primary
CNP-01544
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01500759
—
NM
Enumeration date
06/19/2005
Last updated
03/04/2010
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