Individual
RAELYNN BENALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 397-5172
(877) 396-1184
Mailing address
2111 COLLEGE DR, GALLUP, NM 87301-5600
(505) 397-5172
(877) 396-1184
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-75921
NM
363LF0000X
Family Nurse Practitioner
Primary
85128
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N0011073
—
NM
Enumeration date
12/16/2016
Last updated
01/28/2026
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