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General NPI Number Information
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NPI Number | 1124752738
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Entity Type | Organization
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Legal Business Name | COMMON GROUND COMMUNITY CARE
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 332 LOS RANCHOS RD NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6531
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Country | US
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Telephone | 952-913-6422
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Fax |
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Provider Business Mailing Address
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Address Line | 332 LOS RANCHOS RD NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6531
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Country | US
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Telephone | 952-913-6422
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JENNIFER ANN ROBINSON
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Credential | CNP
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Telephone | 952-913-6422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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