Healthcare Provider Details

I. General information

NPI: 1336589969
Provider Name (Legal Business Name): JENIFER ANN DEZIEL APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOSTER LANE
RESERVE NM
87830
US

IV. Provider business mailing address

829 N MANZANITA ST
LAS CRUCES NM
88001-2248
US

V. Phone/Fax

Practice location:
  • Phone: 575-277-9562
  • Fax: 575-533-6313
Mailing address:
  • Phone: 575-277-9562
  • Fax: 575-533-6313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number57338
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: