Healthcare Provider Details

I. General information

NPI: 1467760512
Provider Name (Legal Business Name): AMBER EICHSTEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MOON CIR
EDGEWOOD NM
87015-8785
US

IV. Provider business mailing address

9 MOON CIR
EDGEWOOD NM
87015-8785
US

V. Phone/Fax

Practice location:
  • Phone: 505-259-8664
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB20250931
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: