Provider Demographics
NPI:1538532312
Name:LICHTENSTEIN, MARCIE (FNP)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:LICHTENSTEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 HOSPITAL DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4772
Mailing Address - Country:US
Mailing Address - Phone:505-983-6774
Mailing Address - Fax:888-707-2979
Practice Address - Street 1:1630 HOSPITAL DR
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4772
Practice Address - Country:US
Practice Address - Phone:505-983-6774
Practice Address - Fax:888-707-2979
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily