Jillian Marie Beausoleil, IDMT
Individual provider Active NPI Independent Duty Medical Technicians · Cannon Afb, NM
NPI 1053554204 · NPPES record last updated Oct 6, 2011
Key facts
- NPI
- 1053554204
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Medical Technicians 1710I1003X
- Practice address
- 511 N Torch Blvd RM 102B
Cannon Afb, NM 88103-5109 - Phone
- (575) 784-0287
- NPI assigned
- Apr 16, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Medical Technicians | 1710I1003X | Yes |
Addresses
Primary practice location
511 N Torch Blvd RM 102B
Cannon Afb, NM 88103-5109
Mailing address
1204 Rosewood Dr
Clovis, NM 88101-9391
Other providers in Cannon Afb, NM
- Elisha Apawan
- Leanyelit Katiuska Atkinson
- Rachael Christine Auger
- Nancy Barquin Barron
- Matthew Richard Bass
- Nicholas E Bem
- Ashton Nicole Bierbrauer-Martin
- Tara Rene Blackwelder
- Ericka Jean Bond
- Bryan W Bovitz
All providers in Cannon Afb, NM · Independent Duty Medical Technicians in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.