Individual
GRACE M GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 766-5197
Mailing address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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