Organization
GRACE PLACE FOR WOMEN, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH JOSLIN (CEO)
(505) 327-4747
Entity
Organization
Contact information
Practice address
4801 N BUTLER AVE STE 3102, FARMINGTON, NM 87401-0815
(505) 327-4747
(505) 327-2025
Mailing address
PO BOX 2256, FARMINGTON, NM 87499-2256
(505) 327-4747
(505) 327-2025
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD2010-0229
NM
207V00000X
Obstetrics & Gynecology Physician
MD2010-0578
NM
363A00000X
Physician Assistant
PA2008-0053
NM
Other
Enumeration date
09/02/2011
Last updated
05/23/2012
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