Individual
JASMINE NICHOLE ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4501 SAFELITE BLVD NE APT 2117, RIO RANCHO, NM 87144-9105
(505) 274-3980
Mailing address
4501 SAFELITE BLVD NE APT 2117, RIO RANCHO, NM 87144-9105
(505) 274-3980
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
515276998
NM
Other
Enumeration date
04/27/2023
Last updated
04/27/2023
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