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1407158298
TEDDEY PROVENCIO
LAS CRUCES, NM
NPI
1407158298
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2010-11-30
Last Update Date
2010-11-30
Business Address
-- TEDDEY PROVENCIO
118 S MAIN ST
LAS CRUCES, NM 88001
Phone number: 575-527-7975
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Mailing Address
-- TEDDEY PROVENCIO
100 W GRIGGS AVE
LAS CRUCES, NM 88001-1234
Phone number: 575-647-2800
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