MEDICARE: DR. MARGARET FERN EDMISTON PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53740	NM

General Provider Information

NPI Number	:	1447727136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARGARET FERN EDMISTON PMHNP

Provider Business Mailing Address
First Line	:	2155 LOUISIANA BLVD NE STE 1200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5495
Country	:	US
Telephone Number	:	505-591-5148
Fax Number	:	999-999-9999

Provider Business Practice Location Address
First Line	:	2155 LOUISIANA BLVD NE STE 1200
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-5495
Country	:	US
Telephone Number	:	505-591-5148
Fax Number	:

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

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	03/17/2026

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