Individual
REGINA DEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2015 E 12TH ST, FARMINGTON, NM 87401-7460
(505) 326-2695
Mailing address
2015 E 12TH ST, FARMINGTON, NM 87401-7460
(505) 326-2695
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174V00000X
—
NM
Enumeration date
09/24/2014
Last updated
09/24/2014
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