Healthcare Provider Details

I. General information

NPI: 1972020915
Provider Name (Legal Business Name): MARTI JILL HOEKENGA-RIGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 S TELSHOR BLVD STE A
LAS CRUCES NM
88011-4731
US

IV. Provider business mailing address

1240 S TELSHOR BLVD STE A
LAS CRUCES NM
88011-4731
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9776
  • Fax: 575-652-4666
Mailing address:
  • Phone: 575-556-9776
  • Fax: 575-652-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03351
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: