Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 92-74 | NM |
NPI | 1265442297 |
---|---|
Provider Name | Deborah Jean Hewitt |
First Address | Ruidoso, NM 88345-6090 |
Second Address | Ruidoso, NM 88345-6089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
850402108 | TAX ID (01) | NM |
E4918 | (05) | NM |
F29077 | (02) | NM |