Healthcare Provider Details

I. General information

NPI: 1932600442
Provider Name (Legal Business Name): ELIZABETH B. JEZEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 04/05/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W PRINCESS JEANNE DR
HOBBS NM
88240-3513
US

IV. Provider business mailing address

1600 W PRINCESS JEANNE DR
HOBBS NM
88240-3513
US

V. Phone/Fax

Practice location:
  • Phone: 575-441-7763
  • Fax: 575-390-6778
Mailing address:
  • Phone: 575-441-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR22291
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR22291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: