Individual
MARYLEE ROSE PFANNENSTIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
US HWY 64 OLD HIGH SCHOOL RD, SHIPROCK, NM 87420-1199
(505) 368-5163
(505) 368-5502
Mailing address
PO BOX 1199, SHIPROCK, NM 87420-1199
(505) 368-5163
(505) 368-5502
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN-69686
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
J7695
—
NM
Enumeration date
08/01/2017
Last updated
08/01/2017
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