MEDICARE: ANDREI MARCHENKO CNP

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	363L00000X	Nurse Practitioner	CNP01745	NM

General Provider Information

NPI Number	:	1225336910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREI MARCHENKO CNP

Provider Business Mailing Address
First Line	:	10401 MONTGOMERY PKWY NE STE 150
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3876
Country	:	US
Telephone Number	:	505-234-1040
Fax Number	:	505-407-8150

Provider Business Practice Location Address
First Line	:	10401 MONTGOMERY PKWY NE STE 150
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3876
Country	:	US
Telephone Number	:	505-234-1040
Fax Number	:	505-407-8150

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

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	02/02/2012

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