Provider Demographics
NPI:1447231261
Name:LENTE, IAN-MICHAEL ANTHONY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:IAN-MICHAEL
Middle Name:ANTHONY
Last Name:LENTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 ASH ST. S.E.
Mailing Address - Street 2:APT. #1-B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-977-1574
Mailing Address - Fax:
Practice Address - Street 1:1010 BRIDGE BLVD SW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-3765
Practice Address - Country:US
Practice Address - Phone:505-508-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM 84PA010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM990283OtherUNMH PROVIDER NUMBER
NMR96662Medicare UPIN