Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 56569 | NM |
NPI | 1003477969 |
---|---|
Provider Name | Erin Tinker |
First Address | Farmington, NM 87499-6210 |
Second Address | Farmington, NM 87401-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 21/06/2019 |