Active NPI
Angelique S Crandall, L.D.
- Registered Dietitian
- Albuquerque, NM
National Provider Identifier
1386926764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-0825
- Practice address
- 7510 Montgomery Blvd NE Ste 203
Albuquerque, NM 87109-1500 - Phone
- (505) 855-5545
- NPI assigned
- Sep 13, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD-0825 | NM | Primary |
Addresses
Primary practice location
7510 Montgomery Blvd NE Ste 203
Albuquerque, NM 87109-1500
Mailing address
7510 Montgomery Blvd NE Ste 203
Albuquerque, NM 87109-1500
Phone (505) 855-5545
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LD-0825 | Other | NM | STATE OF NM BOARD OF NUTRITION PRACTITIONERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD-0825 | NM | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402531200000",
"number": "1386926764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7510 MONTGOMERY BLVD NE STE 203",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871091500",
"telephone_number": "505-855-5545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7510 MONTGOMERY BLVD NE STE 203",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871091500",
"telephone_number": "505-855-5545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRANDALL",
"first_name": "ANGELIQUE",
"middle_name": "S",
"credential": "L.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-13",
"last_updated": "2014-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NM",
"license": "LD-0825",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF NM BOARD OF NUTRITION PRACTITIONERS",
"identifier": "LD-0825",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.