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General NPI Number Information
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NPI Number | 1598809717
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Entity Type | Individual
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Provider Name | MARY KERWIN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1170 N SOLANO DR STE A
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City | LAS CRUCES
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State | NM
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Zip | 88001-2371
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Country | US
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Telephone | 505-528-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 1855 EVANS PL
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City | LAS CRUCES
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State | NM
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Zip | 88001-5314
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Country | US
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Telephone |
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Fax |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R24445
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License Number State | NM
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