Healthcare Provider Details

I. General information

NPI: 1609047703
Provider Name (Legal Business Name): ANNA M RIDER MFA, CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LUISA ST STE O
SANTA FE NM
87505-4073
US

IV. Provider business mailing address

2849 VEREDA DE PUEBLO
SANTA FE NM
87507-5361
US

V. Phone/Fax

Practice location:
  • Phone: 505-690-8618
  • Fax:
Mailing address:
  • Phone: 505-690-8618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12089
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: