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General NPI Number Information
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NPI Number | 1184864043
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Entity Type | Individual
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Provider Name | MARLA D. JIM RN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 129 MEDICINE HORSE DRIVE
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City | CANONCITO
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State | NM
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Zip | 87026
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Provider Business Mailing Address
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Address Line | PO BOX 3338
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City | TOHAJIILEE
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State | NM
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Zip | 87026-3338
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Country | US
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Telephone | 505-908-2307
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Fax | 505-908-2310
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN-69198
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License Number State | NM
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