Basic Information
Provider Information
NPI: 1003010232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRYE
FirstName: ERIN
MiddleName: H
NamePrefix: MRS.
NameSuffix:  
Credential: LMT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 FIRST PLAZA CTR NW STE 67
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871023347
CountryCode: US
TelephoneNumber: 5052471469
FaxNumber:  
Practice Location
Address1: 20 FIRST PLAZA CTR NW STE 67
Address2:  
City: ALBUQUERQUE
State: NM
PostalCode: 871023347
CountryCode: US
TelephoneNumber: 5052471469
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/12/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175F00000X5390NMY Other Service ProvidersNaturopath 

No ID Information.


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