Provider Demographics
NPI:1275531535
Name:ENMU-ROSWELL
Entity Type:Organization
Organization Name:ENMU-ROSWELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MA
Authorized Official - Phone:505-624-7233
Mailing Address - Street 1:PO BOX 6000
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-6000
Mailing Address - Country:US
Mailing Address - Phone:505-624-7233
Mailing Address - Fax:505-624-7100
Practice Address - Street 1:809 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-3801
Practice Address - Country:US
Practice Address - Phone:505-625-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10725363L00000X
NM30665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty