Healthcare Provider Details

I. General information

NPI: 1477953826
Provider Name (Legal Business Name): MAUREEN ELIZABETH MAHER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 CARDENAS DR NE
ALBUQUERQUE NM
87110-3207
US

IV. Provider business mailing address

2935 CARDENAS NE
ALBUQUERQUE NM
87110-3207
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-5181
  • Fax: 505-272-6217
Mailing address:
  • Phone: 505-888-5181
  • Fax: 505-272-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberLD-320
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: