MEDICARE: MELISSA ANNE GZASKOW RN, LMT

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	R58980	NM
2	163WI0500X	Infusion Therapy Registered Nurse	R58980	NM
3	163WM1400X	Nurse Massage Therapist (NMT)	2770	NM
4	163WP2201X	Ambulatory Care Registered Nurse	R58980	NM
5	163WX0200X	Oncology Registered Nurse	R58980	NM

General Provider Information

NPI Number	:	1598139115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ANNE GZASKOW RN, LMT

Provider Business Mailing Address
First Line	:	66 AVENIDA ALDEA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-9449
Country	:	US
Telephone Number	:	505-795-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 AVENIDA ALDEA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-9449
Country	:	US
Telephone Number	:	505-795-7111
Fax Number	:

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

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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