MEDICARE: MAEYER EDMONDSON REIKI PRACTITIONER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1902181845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAEYER EDMONDSON REIKI PRACTITIONER

Provider Business Mailing Address
First Line	:	926 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4214
Country	:	US
Telephone Number	:	505-425-1442
Fax Number	:	505-425-1442

Provider Business Practice Location Address
First Line	:	926 8TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4214
Country	:	US
Telephone Number	:	505-425-1442
Fax Number	:	505-425-1442

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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Directions to “ MAEYER EDMONDSON REIKI PRACTITIONER” Practice Location

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