Individual
CHANTALA BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2422 STATE HIGHWAY 333, MORIARTY, NM 87035
(505) 274-3354
Mailing address
PO BOX 604, MORIARTY, NM 87035-0604
(505) 274-3354
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN-82148
NM
Other
Enumeration date
09/04/2024
Last updated
09/04/2024
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