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NPI Code Detail

MEDICARE: MRS. DEBRA TOUSLEY RD, LD

MEDICARE:  MRS. DEBRA  TOUSLEY  RD, LD
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
1133V00000XRegistered Dietitian390NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1859481OTHERADA LICENSE

General Provider Information

NPI Number : 1962509380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBRA TOUSLEY RD, LD
Provider Business Mailing Address
First Line : PO BOX 6880
Second Line :
City : SANTA FE
State : NM
Zip : 87502-6880
Country : US
Telephone Number : 505-216-0332
Fax Number : 505-982-0279
Provider Business Practice Location Address
First Line : 4710 JEFFERSON ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87109-2155
Country : US
Telephone Number : 505-955-9454
Fax Number : 505-888-9644
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 05/08/2025

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Directions to “ MRS. DEBRA TOUSLEY RD, LD” Practice Location

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