1366799546 NPI number — MRS. ALANA NICOLE RIEKER LSAA,LMSW

Table of content: MRS. ALANA NICOLE RIEKER LSAA,LMSW (NPI 1366799546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366799546 NPI number — MRS. ALANA NICOLE RIEKER LSAA,LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIEKER
Provider First Name:
ALANA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSAA,LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366799546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 N BUTLER AVE
Provider Second Line Business Mailing Address:
SUITE 211
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87401-5621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-608-7398
Provider Business Mailing Address Fax Number:
505-634-7044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3300 N BUTLER AVE
Provider Second Line Business Practice Location Address:
SUITE 211
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87401-5621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-608-7398
Provider Business Practice Location Address Fax Number:
505-634-7044
Provider Enumeration Date:
08/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  0150681 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: M-08192 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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