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General NPI Number Information
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NPI Number | 1295211340
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Entity Type | Organization
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Legal Business Name | RIP & SNORT HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/12/2018
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 110 SOLANO RD
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City | PIE TOWN
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State | NM
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Zip | 87827
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Country | US
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Telephone | 520-488-1756
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Fax | 888-614-3881
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Provider Business Mailing Address
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Address Line | PO BOX 781
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City | PIE TOWN
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State | NM
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Zip | 87827-0781
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Country | US
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Telephone | 520-488-1756
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Fax | 888-614-3881
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Authorized Official
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Title or Position | PROVIDER/ADMINISTRATOR
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Name | DEVONNA ANNE JOHNSON
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Credential | FNP-C
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Telephone | 520-488-1756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State | NM
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