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NPI Code Detail

MEDICARE: MS. JANE PRINCE SMITH MSW

MEDICARE: MS. JANE PRINCE SMITH MSW
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
11041C0700XClinical Social WorkerI 2539NM

General Provider Information

NPI Number : 1538150719
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JANE PRINCE SMITH MSW
Provider Business Mailing Address
First Line : PO BOX 2427
Second Line : 133 RINCON LOOP
City : TIJERAS
State : NM
Zip : 87059-2427
Country : US
Telephone Number : 505-186-1319
Fax Number :
Provider Business Practice Location Address
First Line : 2600 MARBLE AVE NE
Second Line : BLDG 2
City : ALBUQUERQUE
State : NM
Zip : 87106-2058
Country : US
Telephone Number : 505-220-7880
Fax Number : 505-288-3573
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2005
Last Update Date : 06/19/2012

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Directions to “ MS. JANE PRINCE SMITH MSW” Practice Location

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