Healthcare Provider Details

I. General information

NPI: 1689606022
Provider Name (Legal Business Name): MARGARETHA KATHARINA JENNESS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TENTH STREET
MAGDALENA NM
87825
US

IV. Provider business mailing address

PO BOX 366
MAGDALENA NM
87825-0366
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-5094
  • Fax: 575-835-5097
Mailing address:
  • Phone: 575-854-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR44314
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: