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General NPI Number Information
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NPI Number | 1689804791
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Entity Type | Individual
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Provider Name | MRS. CAROL DENISE MANCHESTER-BROWN
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Gender | Female
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 723 VIRGINIA AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6758
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Country | US
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Telephone | 575-937-0977
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Fax | 575-257-1569
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Provider Business Mailing Address
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Address Line | PO BOX 8032
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City | RUIDOSO
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State | NM
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Zip | 88355-8032
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Country | US
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Telephone | 575-937-0977
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Fax | 575-257-1569
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number | 2206 QBS
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License Number State |
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