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General NPI Number Information
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NPI Number | 1891209235
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Entity Type | Organization
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Legal Business Name | FORT SUMNER SCHOOLS
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 262 SOUTH 9TH STREET ELEMENTARY SCHOOL BUILDING
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City | FORT SUMNER
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State | NM
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Zip | 88119-9316
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Country | US
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Telephone | 575-355-7716
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Fax | 575-355-6002
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Provider Business Mailing Address
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Address Line | 765 EAST SUMNER AVENUE
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City | FORT SUMNER
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State | NM
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Zip | 88119
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Country | US
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Telephone | 575-355-7766
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Fax | 575-355-6002
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Authorized Official
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Title or Position | SCHOOL NURSE
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Name | MARIE ALICE DICKERMAN
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Credential | REGISTERED NURSE
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Telephone | 575-355-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | R28287
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License Number State | NM
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