Healthcare Provider Details

I. General information

NPI: 1619600236
Provider Name (Legal Business Name): NEW DAWN PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 N ORCHARD
ESPANOLA NM
87532-3232
US

IV. Provider business mailing address

1308 N ORCHARD
ESPANOLA NM
87532-3232
US

V. Phone/Fax

Practice location:
  • Phone: 505-927-0157
  • Fax:
Mailing address:
  • Phone: 505-927-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFIN MARIE ZELLERS
Title or Position: OWNER
Credential: DNP
Phone: 505-927-0157