MEDICARE: LAURA AMANDA NIETFELD MD

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
1	207Q00000X	Family Medicine Physician	Q0801	TX

General Provider Information

NPI Number	:	1669601092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA AMANDA NIETFELD MD

Provider Business Mailing Address
First Line	:	11130 CHRISTUS HILLS
Second Line	:	MEDICAL PLAZA 3, 3RD FLOOR
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3585
Country	:	US
Telephone Number	:	210-703-9001
Fax Number	:	210-703-9155

Provider Business Practice Location Address
First Line	:	11130 CHRISTUS HILLS
Second Line	:	MEDICAL PLAZA 3, 3RD FLOOR
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-3585
Country	:	US
Telephone Number	:	210-703-9001
Fax Number	:	210-703-9155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	07/09/2021

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