| Doctor Name: | MS. PRISCILLA T CARRILLO |
| NPI Number: | 1922022995 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | R53479 |
| Business Practice Address: | 12000 Stone Lake Rd. Dulce, NM - 87528 |
| Business Phone Number: | 5757593291 |
| Business Fax Number: | |
| Mailing Address: | Hc 75 Box 53a, CHAMA |
| State: | NM |
| Postal Code: | 875209702 |
| Phone Number: | 5059294962 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 09/15/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP2201X |
| License Number: | R53479 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ambulatory Care |
| Taxonomy Definition: | |