Healthcare Provider Details

I. General information

NPI: 1942554266
Provider Name (Legal Business Name): DIM CARE MOBLE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N ROADRUNNER PKWY
LAS CRUCES NM
88011-9051
US

IV. Provider business mailing address

PO BOX 2801
LAS CRUCES NM
88004-2801
US

V. Phone/Fax

Practice location:
  • Phone: 575-805-0560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP01884
License Number StateNM

VIII. Authorized Official

Name: JENNIFER NWAOGU
Title or Position: OWNER
Credential: CNP
Phone: 575-805-0560