Provider Demographics
NPI:1578727699
Name:ROTTMAN, INEZ SARGENT (RPH EMT BASIC)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:SARGENT
Last Name:ROTTMAN
Suffix:
Gender:F
Credentials:RPH EMT BASIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E FLORIDA
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030
Mailing Address - Country:US
Mailing Address - Phone:575-546-2731
Mailing Address - Fax:
Practice Address - Street 1:820 E FLORIDA
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030
Practice Address - Country:US
Practice Address - Phone:575-546-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist