| Doctor Name: | MARY LORING DAGGETT |
| NPI Number: | 1265551469 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHYSICIAN ASSISTANT |
| License Number: | 95-PA30 |
| Business Practice Address: | Bikini Atoll Road Ms D421 Los Alamos, NM - 87545 |
| Business Phone Number: | 5056652631 |
| Business Fax Number: | |
| Mailing Address: | 2305 Calle Pintura, SANTA FE |
| State: | NM |
| Postal Code: | 875055273 |
| Phone Number: | 5054712569 |
| Fax Number: | |
| NPI Enumeration Date: | 03/28/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 95-PA30 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |