Healthcare Provider Details

I. General information

NPI: 1275531535
Provider Name (Legal Business Name): ENMU-ROSWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 W ALAMEDA ST
ROSWELL NM
88203-3801
US

IV. Provider business mailing address

PO BOX 6000
ROSWELL NM
88202-6000
US

V. Phone/Fax

Practice location:
  • Phone: 505-625-6975
  • Fax:
Mailing address:
  • Phone: 505-624-7233
  • Fax: 505-624-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number30665
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10725
License Number StateNM

VIII. Authorized Official

Name: JANE BATSON
Title or Position: DIVISION CHAIRPERSON
Credential: RN, MA
Phone: 505-624-7233