Provider Demographics
NPI:1982499620
Name:VON AMELUNXEN, DEMI
Entity type:Individual
Prefix:
First Name:DEMI
Middle Name:
Last Name:VON AMELUNXEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:DEMITRIA
Other - Middle Name:
Other - Last Name:VON AMELUNXEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4524
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-4524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9007 WASHINGTON ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2722
Practice Address - Country:US
Practice Address - Phone:505-503-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program