Healthcare Provider Details

I. General information

NPI: 1215585369
Provider Name (Legal Business Name): ROSEMARIE DOMANQUE HARTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 WAC PL
BELEN NM
87002-8185
US

IV. Provider business mailing address

4 WAC PL
BELEN NM
87002-8185
US

V. Phone/Fax

Practice location:
  • Phone: 505-861-5541
  • Fax:
Mailing address:
  • Phone: 505-861-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: