Provider Demographics
NPI:1043229115
Name:NOREM, ARDYTH A (PHS)
Entity Type:Individual
Prefix:DR
First Name:ARDYTH
Middle Name:A
Last Name:NOREM
Suffix:
Gender:F
Credentials:PHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E CHILI LINE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-1395
Mailing Address - Country:US
Mailing Address - Phone:505-473-4017
Mailing Address - Fax:
Practice Address - Street 1:15 E CHILI LINE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-1395
Practice Address - Country:US
Practice Address - Phone:505-473-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0817103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00JM96OtherBCBS
NM36573353Medicaid
NM89991OtherPRESBYTERIAN
NMP00073759OtherRAILROAD MEDICARE