MEDICARE: WOMEN IN LEADERSHIP NEW MEXICO INC

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1639947252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN IN LEADERSHIP NEW MEXICO INC

Provider Business Mailing Address
First Line	:	300 CENTRAL AVE SW STE 1500
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102-3298
Country	:	US
Telephone Number	:	505-369-1731
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CENTRAL AVE SW
Second Line	:	1500 EAST
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87102
Country	:	US
Telephone Number	:	505-369-1731
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STACY BURLESON
Credential	:	CPSW
Telephone Number	:	505-369-1731

Provider Enumeration Date	:	12/13/2023
Last Update Date	:	12/13/2023

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