MEDICARE: ANGELA TIPTON 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	171W00000X	Contractor	7406	NM

General Provider Information

NPI Number	:	1649615188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA TIPTON LMT

Provider Business Mailing Address
First Line	:	1107 CANYON RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-6125
Country	:	US
Telephone Number	:	858-243-8635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 CANYON RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-6125
Country	:	US
Telephone Number	:	858-243-8635
Fax Number	:

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

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	05/09/2013

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