Healthcare Provider Details

I. General information

NPI: 1023455698
Provider Name (Legal Business Name): AMBER KRISTIE SENA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6558 FREEMONT HILLS LOOP NE
RIO RANCHO NM
87144-0810
US

IV. Provider business mailing address

6558 FREEMONT HILLS LOOP NE
RIO RANCHO NM
87144-0810
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-6505
  • Fax:
Mailing address:
  • Phone: 505-228-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7570
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: