Individual
JENNIFER ANTILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
32 PASEO DEL VALLE, SANTA FE, NM 87508-1402
(505) 603-1629
Mailing address
PO BOX 6402, SANTA FE, NM 87502-6402
(505) 603-1629
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7783
NM
Other
Enumeration date
02/05/2014
Last updated
01/20/2016
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