Healthcare Provider Details

I. General information

NPI: 1932773025
Provider Name (Legal Business Name): JOLYNN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2465 S TELSHOR BLVD
LAS CRUCES NM
88011-5049
US

IV. Provider business mailing address

3420 CALLE BEDADO
LAS CRUCES NM
88007-8096
US

V. Phone/Fax

Practice location:
  • Phone: 575-339-1080
  • Fax:
Mailing address:
  • Phone: 985-514-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number63692
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: