Provider Demographics
NPI:1427462266
Name:JIRON, NADINE
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JIRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 MESA BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-3039
Mailing Address - Country:US
Mailing Address - Phone:505-285-3672
Mailing Address - Fax:
Practice Address - Street 1:1041 MESA BLVD STE D
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3039
Practice Address - Country:US
Practice Address - Phone:505-285-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst