Provider Demographics
NPI:1891209235
Name:FORT SUMNER SCHOOLS
Entity Type:Organization
Organization Name:FORT SUMNER SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:DICKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:575-355-7766
Mailing Address - Street 1:765 EAST SUMNER AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119
Mailing Address - Country:US
Mailing Address - Phone:575-355-7766
Mailing Address - Fax:575-355-6002
Practice Address - Street 1:262 SOUTH 9TH STREET
Practice Address - Street 2:ELEMENTARY SCHOOL BUILDING
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119-9316
Practice Address - Country:US
Practice Address - Phone:575-355-7716
Practice Address - Fax:575-355-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR28287251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care