Individual
ETHEL SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1110 E. HIGH STREET, TUCUMCARI, NM 88401
(575) 461-4411
(575) 461-4102
Mailing address
P.O. BOX 28820, SANTA FE, NM 87592
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/14/2011
Last updated
03/14/2011
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