Healthcare Provider Details

I. General information

NPI: 1184138596
Provider Name (Legal Business Name): DONNA ROSEANN MERSMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 W FOX ST
CARLSBAD NM
88220-6212
US

IV. Provider business mailing address

114 W FOX ST
CARLSBAD NM
88220-6212
US

V. Phone/Fax

Practice location:
  • Phone: 575-236-1001
  • Fax:
Mailing address:
  • Phone: 575-236-1001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH3326
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: