Provider Demographics
NPI:1679506141
Name:DUQUETTE, DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:DUQUETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 CALLE VIANSON
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5013
Mailing Address - Country:US
Mailing Address - Phone:505-695-5065
Mailing Address - Fax:
Practice Address - Street 1:4801 BECKNER RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3641
Practice Address - Country:US
Practice Address - Phone:505-772-2000
Practice Address - Fax:505-772-6297
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036465207V00000X
NMMD2010-0661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0235120OtherL&I
WA8231086Medicaid
G75928Medicare UPIN
WA8231086Medicaid