Individual
MARYANN T PARK
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
PO BOX 966, JAMESTOWN, NM 87347-0966
(708) 466-2244
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041470436
IL
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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