Individual
TIFFANY HENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4805 SAMANTHA LN, FARMINGTON, NM 87402-3053
(505) 947-2341
Mailing address
4805 SAMANTHA LN, FARMINGTON, NM 87402-3053
(505) 947-2341
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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