Healthcare Provider Details

I. General information

NPI: 1144643297
Provider Name (Legal Business Name): JANIS KATRINA MARQUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTRAL AVE
BAYARD NM
88023
US

IV. Provider business mailing address

900 CENTRAL AVE
BAYARD NM
88023
US

V. Phone/Fax

Practice location:
  • Phone: 575-537-4000
  • Fax:
Mailing address:
  • Phone: 575-537-4000
  • Fax: 575-537-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR67051
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: