Healthcare Provider Details

I. General information

NPI: 1134603442
Provider Name (Legal Business Name): AIMEE M GARRETT RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 1ST ST
BLOOMFIELD NM
87413-5359
US

IV. Provider business mailing address

520 N 1ST ST
BLOOMFIELD NM
87413-5359
US

V. Phone/Fax

Practice location:
  • Phone: 505-634-3405
  • Fax:
Mailing address:
  • Phone: 505-634-3405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-71769
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: