Individual
PENNY DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCSS
Contact information
Practice address
614 BECKER AVE, BELEN, NM 87002-3634
(575) 835-4357
(505) 514-0732
Mailing address
PO BOX 456, BELEN, NM 87002-0456
(575) 835-4357
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/05/2023
Last updated
05/06/2023
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