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General NPI Number Information
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NPI Number | 1912468232
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Entity Type | Individual
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Provider Name | JENNIFER PROSSER MD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 2025 GALISTEO ST
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City | SANTA FE
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State | NM
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Zip | 87505-2101
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Country | US
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Telephone | 505-913-3450
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5451
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City | SANTA FE
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State | NM
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Zip | 87502-5451
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2022-1000
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License Number State | NM
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