Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RO8229 | NM |
NPI | 1003851270 |
---|---|
Provider Name | Ms. Martha Jean Wertz |
First Address | Las Cruces, NM 88011-7623 |
Second Address | Las Cruces, NM 88011-7623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |