Individual
MARY PATRICIA WILLMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
620 CORONADO ST., ESPANOLA, NM 87532
(505) 753-7395
Mailing address
2185 44TH ST, APT. D, LOS ALAMOS, NM 87544-1750
(505) 662-9843
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD-0659
NM
Other
Enumeration date
09/26/2007
Last updated
09/26/2007
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