Provider Demographics
NPI:1912766734
Name:FUHLENDORF, STEPHEN (CPSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:FUHLENDORF
Suffix:
Gender:M
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PASEO DEL CANON W STE A
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6943
Mailing Address - Country:US
Mailing Address - Phone:575-737-5533
Mailing Address - Fax:575-737-5534
Practice Address - Street 1:412 SIPAPU ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6498
Practice Address - Country:US
Practice Address - Phone:575-737-5533
Practice Address - Fax:575-737-5534
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator