| NPI | 1417573338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA JOY JACCARD Owner 505-228-2853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |