Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | X-11822 | NM |
NPI | 1003408527 |
---|---|
Provider Name | Xena Imari Crespin |
First Address | Las Vegas, NM 87701-4971 |
Second Address | Las Vegas, NM 87701-4971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |