Healthcare Provider Details

I. General information

NPI: 1770591059
Provider Name (Legal Business Name): JILL ANNETTE YARBROUGH LMT RM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL ANNETTE MCCASLAND LMT

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 SOUTH MAIN STREET
EUNICE NM
88231
US

IV. Provider business mailing address

808 SOUTH MAIN STREET
EUNICE NM
88231
US

V. Phone/Fax

Practice location:
  • Phone: 505-394-1466
  • Fax:
Mailing address:
  • Phone: 505-394-1466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number# 2383
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: