MEDICARE: LYSSA M. FRADELLA 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	363LF0000X	Family Nurse Practitioner	76211	NM

General Provider Information

NPI Number	:	1518748185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYSSA M. FRADELLA CNP

Provider Business Mailing Address
First Line	:	800 BRADBURY DR SE STE 116
Second Line	:	STE 116
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 BECKNER RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507
Country	:	US
Telephone Number	:	505-989-4500
Fax Number	:	505-443-8313

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	01/06/2026

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