Individual
MARY JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2240 WINROW AVE, USA MEDDAC,RWBAHC, FORT HUACHUCA, AZ 85613
(520) 533-9033
Mailing address
547 E CAMINO DE MANANA, HUACHUCA CITY, AZ 85616-8137
(520) 559-5705
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP034213
AZ
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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