Individual
JESSICA CHYNOWETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
01 SAGEBRUSH STREET, ISLETA, NM 87022
(505) 869-4385
Mailing address
PO BOX 640, ISLETA, NM 87022
(505) 869-3200
(505) 869-4881
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RS20070280
NM
Other
Enumeration date
04/19/2007
Last updated
06/16/2011
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