Individual
JACQUE NEWMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CO
Contact information
Practice address
221 STATE HIGHWAY 165 STE F, PLACITAS, NM 87043-9514
(505) 353-2484
Mailing address
221 STATE HIGHWAY 165 STE F, PLACITAS, NM 87043-9514
(505) 437-3900
(505) 437-3906
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224900000X
Mastectomy Fitter
—
—
224P00000X
Prosthetist
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06551769
—
NM
Enumeration date
01/08/2021
Last updated
04/24/2025
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