Individual
MRS. MARY J MOGENSEN-LODESERTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 W BROADWAY STE D, FARMINGTON, NM 87401-5638
(505) 325-0328
Mailing address
PO BOX 3239, FARMINGTON, NM 87499-3239
(505) 325-0328
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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