Individual
JACQUELINE DEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 S MISSOURI AVE, ROSWELL, NM 88203-4448
(575) 309-5570
Mailing address
102 S MISSOURI AVE, ROSWELL, NM 88203-4448
(575) 309-5570
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
12/18/2013
Last updated
12/18/2013
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