Healthcare Provider Details

I. General information

NPI: 1386442820
Provider Name (Legal Business Name): DENISE C POWELL CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 S PEARL ST APT 9
DEMING NM
88030-4703
US

IV. Provider business mailing address

1111 S PEARL ST APT 9
DEMING NM
88030-4703
US

V. Phone/Fax

Practice location:
  • Phone: 575-694-1661
  • Fax:
Mailing address:
  • Phone: 575-694-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: