Healthcare Provider Details

I. General information

NPI: 1104714732
Provider Name (Legal Business Name): JAIME LOUISE DRISCOLL BSN, RN, CLNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOSQUE
ALAMOGORDO NM
88310-9532
US

IV. Provider business mailing address

239 BOSQUE
ALAMOGORDO NM
88310-9532
US

V. Phone/Fax

Practice location:
  • Phone: 515-218-4285
  • Fax:
Mailing address:
  • Phone: 515-218-4285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number57420
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number57420
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number57420
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number57420
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License Number57420
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number57420
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number57420
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number57420
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: