Provider Demographics
NPI:1194085340
Name:TENGWALD, KAREN DIANE (LMT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DIANE
Last Name:TENGWALD
Suffix:
Gender:F
Credentials:LMT
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11000 CANDELARIA RD NE
Mailing Address - Street 2:110-E
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1751
Mailing Address - Country:US
Mailing Address - Phone:505-293-1569
Mailing Address - Fax:
Practice Address - Street 1:11000 CANDELARIA NE
Practice Address - Street 2:110-E
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3286
Practice Address - Country:US
Practice Address - Phone:505-293-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0136225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist