Individual
DESERAY NICHOLE SUPRISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2516 CATRON LOOP APT B, HOLLOMAN AFB, NM 88330-7415
(956) 502-7475
Mailing address
2516 CATRON LOOP APT B, HOLLOMAN AFB, NM 88330-7415
(956) 502-7475
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/18/2019
Last updated
07/18/2019
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