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Individual

JENNICA LINES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
114 W 11TH ST, SILVER CITY, NM 88061-5136
(575) 388-1511
Mailing address
114 W 11TH ST, SILVER CITY, NM 88061-5136
(575) 542-3389

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-87926
NM
363LF0000X
Family Nurse Practitioner
Primary
56879
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1730751208
NM
Enumeration date
07/03/2019
Last updated
04/29/2020
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