Basic Information
| Provider Information | |||||||||
| NPI: | 1568770030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLINGER | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | LEA | ||||||||
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| Credential: | CGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC 07 4025 | ||||||||
| Address2: | UNM CANCER RESEARCH AND TREATMENT CENTER | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059250102 | ||||||||
| FaxNumber: | 5059250187 | ||||||||
| Practice Location | |||||||||
| Address1: | MSC 07 4025 | ||||||||
| Address2: | UNM CANCER RESEARCH AND TREATMENT CENTER | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059250102 | ||||||||
| FaxNumber: | 5059250187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2010 | ||||||||
| LastUpdateDate: | 09/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | GC2009-009 | NM | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.