Individual
ANNETTE A MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
180 N DATE ST, T OR C, NM 87901-2810
(575) 894-8372
Mailing address
1321 E POPLAR ST, DEMING, NM 88030-4807
(575) 546-5951
(575) 546-5994
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L15727
NM
Other
Enumeration date
02/05/2019
Last updated
02/05/2019
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