Individual
CHARISSE MERCEDES SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
2960 RODEO PARK DR W, SANTA FE, NM 87505-6351
(505) 986-9633
Mailing address
1405 7TH ST, LAS VEGAS, NM 87701-4212
(575) 517-0162
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
NM
Enumeration date
08/29/2018
Last updated
08/29/2018
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