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Individual

MARILYN NISHITANI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CFNP

Contact information

Practice address
1112 N MAIN ST, ROSWELL, NM 88201-5010
(575) 627-4200
(575) 627-4212
Mailing address
1112 N MAIN ST, ROSWELL, NM 88201-5010
(575) 627-4200
(575) 627-4212

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R35362
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
S4973
NM
Enumeration date
08/16/2005
Last updated
02/05/2016
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