Provider Demographics
NPI:1689606022
Name:JENNESS, MARGARETHA KATHARINA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MARGARETHA
Middle Name:KATHARINA
Last Name:JENNESS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:MAGDALENA
Mailing Address - State:NM
Mailing Address - Zip Code:87825-0366
Mailing Address - Country:US
Mailing Address - Phone:575-854-3410
Mailing Address - Fax:
Practice Address - Street 1:801 TENTH STREET
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825
Practice Address - Country:US
Practice Address - Phone:575-835-5094
Practice Address - Fax:575-835-5097
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR44314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM92023Medicaid
NMMJ0443678OtherDEA NUMBER
NMS87182Medicare ID - Type Unspecified
NM92023Medicaid