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NPI Code Detail

MEDICARE: NAOMI FAHRENKRUG

MEDICARE:   NAOMI  FAHRENKRUG
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982958476
Entity Type Code : Individual
Provider Name (Legal Business Name) : NAOMI FAHRENKRUG
Provider Business Mailing Address
First Line : 385 CALLE DE ALEGRA STE A
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-3423
Country : US
Telephone Number : 575-526-1105
Fax Number : 575-524-4266
Provider Business Practice Location Address
First Line : 3119 EXECUTIVE HILLS RD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-4725
Country : US
Telephone Number : 575-649-4423
Fax Number : 575-524-4266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2012
Last Update Date : 10/16/2015

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Directions to “ NAOMI FAHRENKRUG ” Practice Location

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