KENNETH TISDALE, L.C.I.C.I., LMT #548

Contractor

Active Individual
NPI: 1962709956

Practice Address

201 EUBANK BLVD NE
B1
Albuquerque, NM 87123

Phone: (505) 712-7585

Specialties

Specialty Code Primary License
Contractor 171W00000X Yes LMT # 5488 (NM)

Frequently Asked Questions

NPI 1962709956 is the National Provider Identifier for KENNETH TISDALE, L.C.I.C.I., LMT #548, a Contractor provider located in Albuquerque, NM. This NPI was enumerated on February 28, 2011.
KENNETH TISDALE, L.C.I.C.I., LMT #548 practices at 201 EUBANK BLVD NE, B1, Albuquerque, NM 87123.

Quick Facts

NPI
1962709956
Type
Individual
Enumerated
Feb 28, 2011
Last Updated
Feb 28, 2011

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