| NPI | 1194091603 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA JOY JACCARD Owner 505-228-2853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: NM CNP-01762) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2012-03-29 |