Provider Demographics
NPI:1134215965
Name:CURTIS, DE AYN JACKSON (LMT LICENSED MASSAGE)
Entity type:Individual
Prefix:MRS
First Name:DE AYN
Middle Name:JACKSON
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LMT LICENSED MASSAGE
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 195
Mailing Address - Street 2:
Mailing Address - City:ROWE
Mailing Address - State:NM
Mailing Address - Zip Code:87562
Mailing Address - Country:US
Mailing Address - Phone:505-757-3601
Mailing Address - Fax:
Practice Address - Street 1:#1 MESA BAJA
Practice Address - Street 2:
Practice Address - City:ROWE
Practice Address - State:NM
Practice Address - Zip Code:87562
Practice Address - Country:US
Practice Address - Phone:505-757-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM825225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02214517006OtherTAXATION AND REVENUE DEPT
NM00R56MOtherBLUE CROSS BLUE SHIELD NM