MEDICARE: MARY KERWIN

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	363LW0102X	Women's Health Nurse Practitioner	R24445	NM

General Provider Information

NPI Number	:	1598809717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KERWIN

Provider Business Mailing Address
First Line	:	1855 EVANS PL
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-5314
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1170 N SOLANO DR STE A
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-2371
Country	:	US
Telephone Number	:	505-528-6077
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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