MEDICARE: KEITH LEPSCH

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	163WC0200X	Critical Care Medicine Registered Nurse	R51653	NM

General Provider Information

NPI Number	:	1912861592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH LEPSCH

Provider Business Mailing Address
First Line	:	941 TEWA LOOP
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3210
Country	:	US
Telephone Number	:	505-920-0712
Fax Number	:	505-920-0712

Provider Business Practice Location Address
First Line	:	941 TEWA LOOP
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3210
Country	:	US
Telephone Number	:	505-920-0712
Fax Number	:	505-920-0712

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ KEITH LEPSCH ” Practice Location

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