MEDICARE: MS. ALEXANDRA MARIN RN

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	163W00000X	Registered Nurse	R43491	NM

General Provider Information

NPI Number	:	1528210150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXANDRA MARIN RN

Provider Business Mailing Address
First Line	:	4300 BRYN MAWR DR NE
Second Line	:	APT # 24
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4825
Country	:	US
Telephone Number	:	505-872-2112
Fax Number	:

Provider Business Practice Location Address
First Line	:	7850 JEFFERSON ST NE
Second Line	:	SUITE 200
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4315
Country	:	US
Telephone Number	:	505-223-2008
Fax Number	:

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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