Individual
MS. PRISCILLA T CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12000 STONE LAKE RD., DULCE, NM 87528
(575) 759-3291
Mailing address
HC 75 BOX 53A, CHAMA, NM 87520-9702
(505) 929-4962
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
R53479
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
07/26/2006
Last updated
09/15/2010
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