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Individual

MRS. LISA A WENTLING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
31039 HWY 64 # B, CIMARRON, NM 87714-9646
(575) 376-2402
Mailing address
PO BOX 625, CIMARRON, NM 87714-0625
(575) 376-2402
(575) 376-2107

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2008-0063
NM
207Q00000X
Family Medicine Physician
Primary
PA2008-0063
NM
363AM0700X
Medical Physician Assistant
C0002467
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CS00214130
PHARMACY
NM
01
PA2008-0063
LICENSE
NM
Enumeration date
03/12/2008
Last updated
10/31/2023
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