Healthcare Provider Details

I. General information

NPI: 1982292561
Provider Name (Legal Business Name): JACQUE NEWMAN CO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUE NEWMAN CO

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 STATE HIGHWAY 165 STE F
PLACITAS NM
87043-9514
US

IV. Provider business mailing address

221 STATE HIGHWAY 165 STE F
PLACITAS NM
87043-9514
US

V. Phone/Fax

Practice location:
  • Phone: 505-353-2484
  • Fax:
Mailing address:
  • Phone: 505-437-3900
  • Fax: 505-437-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: