Individual
JEAN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10643 GENTRY LN SW, ALBUQUERQUE, NM 87121-3687
(505) 275-5300
Mailing address
10643 GENTRY LN SW, ALBUQUERQUE, NM 87121-3687
(505) 275-5300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
64385
NM
Other
Enumeration date
11/09/2024
Last updated
11/09/2024
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