Healthcare Provider Details

I. General information

NPI: 1669234472
Provider Name (Legal Business Name): DEMI SNELL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 S TELSHOR BLVD
LAS CRUCES NM
88011-4688
US

IV. Provider business mailing address

1908 PATRICIA CT
LAS CRUCES NM
88001-2019
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-1881
  • Fax:
Mailing address:
  • Phone: 575-805-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: