Healthcare Provider Details

I. General information

NPI: 1073186292
Provider Name (Legal Business Name): JENNIFER DIANE ABERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LA SOMBRA DR SE
LOS LUNAS NM
87031-6777
US

IV. Provider business mailing address

1 LA SOMBRA DR SE
LOS LUNAS NM
87031-6777
US

V. Phone/Fax

Practice location:
  • Phone: 505-710-3335
  • Fax:
Mailing address:
  • Phone: 505-710-3335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2023-0823
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: