Individual
GUY MAX CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
897468
TX
Other
Enumeration date
05/17/2019
Last updated
05/17/2019
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