Individual
AUDREY VICENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 491 NORTH PINON STREET, SHIPROCK, NM 87420-1830
(505) 368-1438
(505) 368-1452
Mailing address
PO BOX 1830, SHIPROCK, NM 87420-1830
(505) 368-1438
(505) 368-1452
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/23/2010
Last updated
11/23/2010
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