Healthcare Provider Details

I. General information

NPI: 1891291357
Provider Name (Legal Business Name): AMELIA REEVE BAXTER-STOLTZFUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4519
US

IV. Provider business mailing address

1101 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4519
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-3053
  • Fax:
Mailing address:
  • Phone: 609-273-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberMD2026-0367
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: