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NPI Code Detail

MEDICARE: AMY JO GARTNER

MEDICARE:   AMY JO GARTNER
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1619506136
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY JO GARTNER
Provider Business Mailing Address
First Line : 1410 MONTE VISTA AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-5730
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1410 MONTE VISTA AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-5730
Country : US
Telephone Number : 575-805-7917
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2020
Last Update Date : 04/06/2020

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Directions to “ AMY JO GARTNER ” Practice Location

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