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Individual

MR. THEODORE DAVID REZNOWSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
R.N.

Contact information

Practice address
607 E APACHE ST, FARMINGTON, NM 87401-6925
(505) 326-2012
Mailing address
PO BOX 496, AZTEC, NM 87410-0496
(505) 427-1831

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN-81941
NM
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
RN-81941
NM
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
RN-81941
NM

Other

Enumeration date
10/28/2015
Last updated
10/28/2015
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