Healthcare Provider Details

I. General information

NPI: 1841976347
Provider Name (Legal Business Name): MARIA LANDRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 PARKWAY DR STE AB
SANTA FE NM
87507-7322
US

IV. Provider business mailing address

PO BOX 449
TESUQUE NM
87574-0449
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-5654
  • Fax:
Mailing address:
  • Phone: 505-983-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: