Provider Demographics
NPI:1629889399
Name:MARIE, AAMUNYTAS
Entity type:Individual
Prefix:
First Name:AAMUNYTAS
Middle Name:
Last Name:MARIE
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:F.A.
Other - Middle Name:
Other - Last Name:MARIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:905 CALLE ARMADA
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3460
Mailing Address - Country:US
Mailing Address - Phone:505-753-0505
Mailing Address - Fax:
Practice Address - Street 1:905 CALLE ARMADA
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3460
Practice Address - Country:US
Practice Address - Phone:505-753-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMG-1627172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker