Jean L Dutra, RPH
Individual provider Active NPI Pharmacist · Mescalero, NM
NPI 1124127501 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124127501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 4480 (NM)
- Practice address
- 318 Abalone Loop
Mescalero Ludian Hospital
Mescalero, NM 88340-0210 - Phone
- (505) 464-4441
- Fax
- (505) 464-4422
- NPI assigned
- Sep 21, 2006
- 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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029534 | MO | MD | Pharmacist |
| 4480 | NM | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 029534 | MO | |
| Pharmacist | 183500000X | 4480 | NM | Yes |
Addresses
Primary practice location
318 Abalone Loop
Mescalero Ludian Hospital
Mescalero, NM 88340-0210
Mailing address
3727 Driftwood Ave
Alamogordo, NM 88310-3727
Phone (505) 437-6162
Other names
- Ms. Jean D Hickey
Other providers in Mescalero, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.