Individual
DONITA SUE DEMONTINEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
80 B VETERANS BLVD, I-40, EXIT 102, ACOMA, NM 87034
(505) 552-5300
(505) 552-5828
Mailing address
PO BOX 130, ATTN ACL PROVIDER ENROLLMENT, SAN FIDEL, NM 87049-0130
(505) 552-5300
(505) 552-5828
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0530
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H3451
—
NM
Enumeration date
11/28/2007
Last updated
02/02/2015
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