MEDICARE: JAIME DENISE COSENS

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	163W00000X	Registered Nurse	63154	NM

General Provider Information

NPI Number	:	1477263945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME DENISE COSENS

Provider Business Mailing Address
First Line	:	PO BOX 696
Second Line	:
City	:	MENTMORE
State	:	NM
Zip	:	87319-0696
Country	:	US
Telephone Number	:	505-870-7584
Fax Number	:

Provider Business Practice Location Address
First Line	:	CORNER ROUTE 7 AND ROUTE 12
Second Line	:
City	:	FORT DEFIANCE
State	:	AZ
Zip	:	86504-8731
Country	:	US
Telephone Number	:	505-870-7584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2022
Last Update Date	:	11/25/2022

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