Individual
MRS. TAMMY LYNN EASTRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
6283 TEASDALE RD, CHARLESTON, MS 38921-9761
(662) 614-0808
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
Primary
862849
MS
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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