Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 5227 | NM |
NPI | 1669750824 |
---|---|
Provider Name | Ms. Tammy Lynn Ray |
First Address | Dexter, NM 88230-9517 |
Second Address | Roswell, NM 88201-2000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2011 |
Last Update Date | 21/07/2011 |