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General NPI Number Information
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NPI Number | 1275531535
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Entity Type | Organization
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Legal Business Name | ENMU-ROSWELL
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 809 W ALAMEDA ST
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City | ROSWELL
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State | NM
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Zip | 88203-3801
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Country | US
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Telephone | 505-625-6975
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6000
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City | ROSWELL
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State | NM
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Zip | 88202-6000
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Country | US
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Telephone | 505-624-7233
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Fax | 505-624-7100
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Authorized Official
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Title or Position | DIVISION CHAIRPERSON
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Name | JANE BATSON
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Credential | RN, MA
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Telephone | 505-624-7233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 30665
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10725
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License Number State | NM
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