MEDICARE: ALEXANDRA STAUTER

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	104100000X	Social Worker	SWB-2026-0610	NM

General Provider Information

NPI Number	:	1639062383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA STAUTER

Provider Business Mailing Address
First Line	:	3150 CARLISLE BLVD NE STE 105
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 COORS BYP NW STE E1
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4055
Country	:	US
Telephone Number	:	505-677-0988
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/03/2026

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Directions to “ ALEXANDRA STAUTER ” Practice Location

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