Individual
CATHERINE BAUTISTA TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
3725 MAYA DR, GALLUP, NM 87301-4560
(754) 308-1294
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2020010755
MO
Other
Enumeration date
04/01/2021
Last updated
04/01/2021
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