Doctor Name: | OLOWAN D DEHERRERA |
NPI Number: | 1447410196 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | R64117 |
Business Practice Address: | I-40 Exit 102 Acl Phs Indian Hospital San Fidel, NM - 870490130 |
Business Phone Number: | 5055525324 |
Business Fax Number: | 5055525490 |
Mailing Address: | Po Box 130, SAN FIDEL |
State: | NM |
Postal Code: | 870490130 |
Phone Number: | 5055525324 |
Fax Number: | 5055525490 |
NPI Enumeration Date: | 06/16/2008 |
NPI Last Update Date: | 06/16/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC1500X |
License Number: | R64117 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |