Healthcare Provider Details

I. General information

NPI: 1215188115
Provider Name (Legal Business Name): HEATHER J ZENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W FLORIDA ST
DEMING NM
88030-6302
US

IV. Provider business mailing address

501 W FLORIDA ST
DEMING NM
88030-6302
US

V. Phone/Fax

Practice location:
  • Phone: 575-546-8841
  • Fax:
Mailing address:
  • Phone: 575-546-8841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number329969
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: