MEDICARE: MAGDALENA ANDERLE LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	7380	NM

General Provider Information

NPI Number	:	1043632979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALENA ANDERLE LMT

Provider Business Mailing Address
First Line	:	PO BOX 441
Second Line	:
City	:	RIBERA
State	:	NM
Zip	:	87560-0441
Country	:	US
Telephone Number	:	415-798-7508
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 LENA ST
Second Line	:	BUILDING C, # 16
City	:	SANTA FE
State	:	NM
Zip	:	87505-3891
Country	:	US
Telephone Number	:	505-216-1661
Fax Number	:	505-216-1661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2014
Last Update Date	:	01/12/2014

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Directions to “ MAGDALENA ANDERLE LMT” Practice Location

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