Individual
ERIN L MATHIESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1823 LARK DR NE, RIO RANCHO, NM 87144-4173
(505) 554-7341
Mailing address
1823 LARK DR NE, RIO RANCHO, NM 87144-4173
(505) 554-7341
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YIE820680575
BLUE CROSS BLUE SHIELD OF NEW MEXICO
NM
Enumeration date
12/21/2017
Last updated
12/21/2017
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