Individual
MARY A NORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
SOCORRO GENERAL MEDICAL GROUP, 1204 US HIGHWAY 60 WEST, SOCORRO, NM 87801
(575) 838-4690
(575) 838-4689
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R16746
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19736550
—
NM
Enumeration date
08/09/2005
Last updated
08/14/2008
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