Individual
OLOWAN D DEHERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
I-40 EXIT 102, ACL PHS INDIAN HOSPITAL, SAN FIDEL, NM 87049-0130
(505) 552-5324
(505) 552-5490
Mailing address
PO BOX 130, SAN FIDEL, NM 87049-0130
(505) 552-5324
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R64117
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R64117
NURSING
NM
Enumeration date
06/16/2008
Last updated
06/16/2008
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