Individual
MS. ELIZABETH J RIEDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 EL LLANO RD, ESPANOLA, NM 87532-6727
(505) 929-1629
(505) 753-5815
Mailing address
PO BOX 158, 538 N. PASEO DE ONATE, ESPANOLA, NM 87532-0158
(505) 753-7218
(505) 753-5815
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
77-PA007
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92726
—
NM
01
—
NM400315
MEDICARE PTAN
NM
Enumeration date
08/31/2005
Last updated
07/01/2013
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