Provider Demographics
NPI:1013259076
Name:MATHES, LENORA MICHELLE (MD)
Entity Type:Individual
Prefix:MS
First Name:LENORA
Middle Name:MICHELLE
Last Name:MATHES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIKI
Other - Middle Name:
Other - Last Name:MATHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2400 UNSER BLVD SE STE 08200
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4740
Practice Address - Country:US
Practice Address - Phone:505-823-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-17
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-04492084S0012X, 2084N0400X
NMRS2013-0429390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program