Provider Demographics
NPI:1487873824
Name:LASKY, ALLISON IRENE (LMT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:IRENE
Last Name:LASKY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 LAS CASITAS
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3028
Mailing Address - Country:US
Mailing Address - Phone:505-984-8733
Mailing Address - Fax:
Practice Address - Street 1:2320 LAS CASITAS
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3028
Practice Address - Country:US
Practice Address - Phone:505-984-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1992171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor