Healthcare Provider Details

I. General information

NPI: 1497536858
Provider Name (Legal Business Name): MICHELE LEANNE MATTHEWS CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 7650
ALBUQUERQUE NM
87106-4911
US

IV. Provider business mailing address

1450 CEDAR LN SE APT B
RIO RANCHO NM
87124-5026
US

V. Phone/Fax

Practice location:
  • Phone: 505-357-3551
  • Fax:
Mailing address:
  • Phone: 575-914-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number100264734
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: