Individual
AMBER GIPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 W AZTEC BLVD, AZTEC, NM 87410-1818
(505) 334-9474
Mailing address
1118 W AZTEC BLVD, AZTEC, NM 87410-1818
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
RN-52935
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN-52935
—
NM
Enumeration date
10/08/2019
Last updated
10/08/2019
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