Individual
KENNETH A JOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DINE' TRADITIONAL
Contact information
Practice address
SOUTHWEST HIGHLAND DRIVE, CROWNPOINT, NM 87313-1144
(505) 786-2111
(505) 786-5442
Mailing address
PO BOX 1144, CROWNPOINT, NM 87313-1144
(505) 786-2111
(505) 786-5442
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DHA 052
DINE' HATAALII
NM
Enumeration date
04/20/2011
Last updated
07/19/2019
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