Individual provider · NPI-1

Nakisha Rae Antonio

Student in an Organized Health Care Education/Training Program · Las Cruces, NM

NPI number1730608480
StatusActive
Last updated in NPPESSep 13, 2017

Details

NPI
1730608480
Entity type
Individual (NPI-1)
Name
Nakisha Rae Antonio
Sex
Female
Sole proprietor
No
Enumeration date
Sep 13, 2017
Last updated
Sep 13, 2017

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
390200000X Student in an Organized Health Care Education/Training Program–NMYes
2255A2300X Specialist/Technologist, Athletic Trainer–NM

Practice location

1815 Wells St
Las Cruces, NM 88003-1304

Phone 575-646-5038

Mailing address

3280 Hillrise Dr
Las Cruces, NM 88011-4778

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