Healthcare Provider Details

I. General information

NPI: 1740972173
Provider Name (Legal Business Name): JAMIE NICOLE ROBILLARD MSN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE N MAXHAM

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CUBA AVE
ALAMOGORDO NM
88310-5727
US

IV. Provider business mailing address

2 DIVERS CV
ALAMOGORDO NM
88310-9519
US

V. Phone/Fax

Practice location:
  • Phone: 575-290-1116
  • Fax:
Mailing address:
  • Phone: 575-290-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74023
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0113508
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: