Individual
MARY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 S SILVER AVE, DEMING, NM 88030-3715
(505) 546-2771
(505) 546-9427
Mailing address
1223 S SANTA CRUZ ST, DEMING, NM 88030-5439
(505) 546-6237
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
R47234
NM
Other
Enumeration date
04/27/2007
Last updated
07/08/2007
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