MEDICARE: MS. LINDA MARIE REINEKE RD, CDE

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	133V00000X	Registered Dietitian	122	NM

General Provider Information

NPI Number	:	1134117286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA MARIE REINEKE RD, CDE

Provider Business Mailing Address
First Line	:	5205 STALLION DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-2277
Country	:	US
Telephone Number	:	505-890-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 UNIVERSITY BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-1734
Country	:	US
Telephone Number	:	505-272-6591
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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