MEDICARE: DEBORAH D WERENKO 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	207Q00000X	Family Medicine Physician	2000-310	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447228119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH D WERENKO MD

Provider Business Mailing Address
First Line	:	1421 LUISA ST STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4073
Country	:	US
Telephone Number	:	505-820-1482
Fax Number	:	505-982-0696

Provider Business Practice Location Address
First Line	:	1421 LUISA ST STE A
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4073
Country	:	US
Telephone Number	:	505-820-1482
Fax Number	:	505-982-0696

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	03/10/2021

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Directions to “ DEBORAH D WERENKO MD” Practice Location

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