Individual
MRS. BERTHA ANN ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
310 LA JARA ST, BLOOMFIELD, NM 87413-6626
(505) 634-3673
(505) 634-3675
Mailing address
712 N 3RD ST., BLOOMFIELD, NM 87413
(505) 634-3673
(505) 634-3675
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
R18502
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64434826
—
NM
Enumeration date
05/17/2007
Last updated
07/09/2007
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