Healthcare Provider Details

I. General information

NPI: 1710271283
Provider Name (Legal Business Name): COURTNEY DUKELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E BROADWAY ST
SILVER CITY NM
88061-5421
US

IV. Provider business mailing address

PO BOX 245
RODEO NM
88056-0245
US

V. Phone/Fax

Practice location:
  • Phone: 800-000-0000
  • Fax:
Mailing address:
  • Phone: --
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9608
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: