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Kenneth Tisdale, L.C.I.C.I., LMT #548 — NPI 1962709956, Albuquerque, NM | NPI Central

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NPI 1962709956

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Kenneth Tisdale, L.C.I.C.I., LMT #548

NPI 1962709956 · Contractor · Albuquerque, NM

Provider details

NPI number: 1962709956
Entity type: Individual
Primary specialty: ContractorOther Service Providers
Credential: L.C.I.C.I., LMT #548
Sex: Male
Sole proprietor: Yes
License: LMT # 5488 (NM)

Specialties & taxonomies

ContractorPrimary171W00000XLicense LMT # 5488 (NM)
Other Service Providers

Practice location

201 Eubank Blvd Ne

B1

Albuquerque, NM 87123

Phone: (505) 712-7585

Approximate (ZIP-level) locationGet directions

More NM providers

Mailing address

8400 Menaul Blvd

Albuquerque, NM 87112

Registry dates

Enumerated: 2011-02-28
Last updated: 2011-02-28

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.