IndividualActive
Jodi Dettman, CNP
NPI 1720269178 · Adult Health Nurse Practitioner · Edgewood, NM
Provider details
- NPI number
- 1720269178
- Entity type
- Individual
- Primary specialty
- Adult Health Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- CNP
- Sex
- Female
- Sole proprietor
- No
- License
- CNP01152 (NM)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
104 Quail Trl Unit B
Edgewood, NM 87015-7185
Phone: (505) 208-0204
Approximate (ZIP-level) locationGet directions
Mailing address
104 Quail Trl Unit B
Edgewood, NM 87015-7185
Registry dates
- Enumerated
- 2007-11-14
- Last updated
- 2018-05-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.