Healthcare Provider Details

I. General information

NPI: 1669344156
Provider Name (Legal Business Name): JADE MARIE JAMROS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-9645
US

IV. Provider business mailing address

590 BOSQUE FARMS BLVD
BOSQUE FARMS NM
87068-9645
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-9283
  • Fax: 505-349-8401
Mailing address:
  • Phone: 505-869-9283
  • Fax: 505-349-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2025-0184
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: