Individual
MARY CROUCH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
118 S. MAIN, LAS CRUCES, NM 88001
(575) 527-7984
Mailing address
100 W GRIGGS AVE, LAS CRUCES, NM 88001-1234
(575) 647-2800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R23247
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47043
—
NM
01
—
850204142
MEDICARE
NM
Enumeration date
09/15/2008
Last updated
09/15/2008
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