Individual
MRS. GAYLIA DIANNE PRIDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12000 STONE LAKE RD, DULCE, NM 87528
(505) 759-7248
(505) 759-7294
Mailing address
PO BOX 752, CHAMA, NM 87520-0752
(505) 756-1598
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
R47562
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
07/31/2006
Last updated
05/28/2008
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