Individual
MRS. DE AYN JACKSON CURTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT LICENSED MASSAGE
Contact information
Practice address
#1 MESA BAJA, ROWE, NM 87562
(505) 757-3601
Mailing address
PO BOX 195, ROWE, NM 87562
(505) 757-3601
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
825
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R56M
BLUE CROSS BLUE SHIELD NM
NM
01
—
02214517006
TAXATION AND REVENUE DEPT
NM
Enumeration date
10/05/2006
Last updated
07/08/2007
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