Individual
MICHELLE STAM-MACLAREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2111 COLLEGE DRIVE, REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, GALLUP, NM 87301
(505) 863-1820
Mailing address
1901 REDROCK DR, PFS DEPT, GALLUP, NM 87301-5683
(505) 863-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
98-397
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002353
LOVELACE HEALTH/SALUD
NM
05
—
433235
—
AZ
01
—
85031326887301A127
CHAMPUS
—
01
—
NM004611
BCBS
NM
01
—
PROVP16359
MOLINA
NM
05
—
S7386
—
NM
Enumeration date
02/06/2006
Last updated
07/09/2007
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