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General NPI Number Information
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NPI Number | 1619600236
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Entity Type | Organization
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Legal Business Name | NEW DAWN PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 09/03/2022
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Provider Practice Location Address
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Address Line | 1308 N ORCHARD
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City | ESPANOLA
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State | NM
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Zip | 87532-3232
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Country | US
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Telephone | 505-927-0157
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 N ORCHARD
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City | ESPANOLA
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State | NM
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Zip | 87532-3232
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Country | US
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Telephone | 505-927-0157
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFIN MARIE ZELLERS
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Credential | DNP
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Telephone | 505-927-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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