Individual
ALYSSA LODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 766-5197
Mailing address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 766-5197
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Enumeration date
06/22/2020
Last updated
06/22/2020
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