MEDICARE: ENMU-ROSWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	30665	NM
2	363L00000X	Nurse Practitioner	10725	NM

General Provider Information

NPI Number	:	1275531535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENMU-ROSWELL

Provider Business Mailing Address
First Line	:	PO BOX 6000
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-6000
Country	:	US
Telephone Number	:	505-624-7233
Fax Number	:	505-624-7100

Provider Business Practice Location Address
First Line	:	809 W ALAMEDA ST
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-3801
Country	:	US
Telephone Number	:	505-625-6975
Fax Number	:

Authorized Official
Title or Position	:	DIVISION CHAIRPERSON
Name	:	JANE BATSON
Credential	:	RN, MA
Telephone Number	:	505-624-7233

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	08/22/2020

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Directions to “ENMU-ROSWELL ” Practice Location

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