Healthcare Provider Details

I. General information

NPI: 1659885382
Provider Name (Legal Business Name): JORIE L WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SCHOOL ST
DORA NM
88115
US

IV. Provider business mailing address

PO BOX 327
DORA NM
88115-0327
US

V. Phone/Fax

Practice location:
  • Phone: 575-477-2211
  • Fax:
Mailing address:
  • Phone: 575-477-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR44592
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: