Individual
MR. WESLEY ERIC ETHERIDGE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
999 W AMADOR AVE STE D, LAS CRUCES, NM 88005-2739
(575) 556-9681
Mailing address
999 W AMADOR AVE STE D, LAS CRUCES, NM 88005-2739
(757) 401-7302
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
NM
Other
Enumeration date
03/23/2021
Last updated
03/23/2021
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