Individual
JENNIFER REDD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 STATE ROAD 30, ESPANOLA, NM 87532-8208
(505) 753-9421
Mailing address
400 STATE ROAD 30, ESPANOLA, NM 87532-8208
(505) 753-9421
(505) 753-5039
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2017-0668
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD2017-0668
MEDICAL LICENSE
NM
Enumeration date
04/04/2014
Last updated
04/18/2018
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