Provider Demographics
NPI:1912202367
Name:JAGOW, RHONDA K (APRN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:K
Last Name:JAGOW
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3851 E LOHMAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8296
Mailing Address - Country:US
Mailing Address - Phone:575-993-5611
Mailing Address - Fax:575-483-7224
Practice Address - Street 1:3851 E LOHMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8296
Practice Address - Country:US
Practice Address - Phone:575-993-5611
Practice Address - Fax:575-483-7224
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX628919363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117582010Medicaid
TX628919OtherLICENSE
TX117582010Medicaid