Individual
JAMIE SHANNON TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
204 CRESTWOOD CT, GALLUP, NM 87301-7120
(808) 352-1128
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
64645
NM
Other
Enumeration date
02/02/2023
Last updated
02/02/2023
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