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NPI Code Detail

MEDICARE: SHELBRA THORLA

MEDICARE:   SHELBRA  THORLA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI05253NM

General Provider Information

NPI Number : 1306059316
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBRA THORLA
Provider Business Mailing Address
First Line : 324 VINEYARD RD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87107-5806
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8015 MOUNTAIN PL RD
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110
Country : US
Telephone Number : 505-463-9539
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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Directions to “ SHELBRA THORLA ” Practice Location

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