MEDICARE: BRICE ENID NOUTHE TIETCHOU MD

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	390200000X	Student in an Organized Health Care Education/Training Program		NM

General Provider Information

NPI Number	:	1316833189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRICE ENID NOUTHE TIETCHOU MD

Provider Business Mailing Address
First Line	:	1 UNIVERSITY OF NEW MEXICO, MSC10 5550 UNITED STATES
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-4661
Fax Number	:	505-272-0475

Provider Business Practice Location Address
First Line	:	1 UNIVERSITY OF NEW MEXICO, MSC10 5550
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-4461
Fax Number	:

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

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	03/16/2026

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