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Individual

MR. MICHAEL WAIDNER HILL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LISW

Contact information

Practice address
2010 INDUSTRIAL PARK RD, ESPANOLA, NM 87532-3600
(505) 753-7395
(505) 753-8373
Mailing address
P.O. BOX 158, 620 N CORONADO AVE, ESPANOLA, NM 87532-0238
(505) 753-7218
(505) 753-5815

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-0088
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
91585
NM
01
NM100915
MEDICARE PTAN
NM
Enumeration date
04/29/2010
Last updated
08/10/2011
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