MEDICARE: MRS. ANICA M. RETHERFORD

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	172V00000X	Community Health Worker		NM
2	374J00000X	Doula		NM

General Provider Information

NPI Number	:	1699665588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANICA M. RETHERFORD

Provider Business Mailing Address
First Line	:	2889 SAN LORENZO CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-1969
Country	:	US
Telephone Number	:	575-649-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	2889 SAN LORENZO CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-1969
Country	:	US
Telephone Number	:	575-649-4403
Fax Number	:

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

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/03/2025

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