Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | CNP-01762 | NM |
NPI | 1033437876 |
---|---|
Provider Name | Ms. Debra Joy Jaccard |
First Address | Bernalillo, NM 87004-5560 |
Second Address | Rio Rancho, NM 87124-1755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 07/04/2017 |