Individual
MRS. JENNIFER ELAINE NYDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., C.N.M.
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FT DEFIANCE, AZ 86504-0649
(928) 729-8000
Mailing address
808 E GREEN AVE, GALLUP, NM 87301-5513
(707) 367-1977
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
1683
CA
367A00000X
Advanced Practice Midwife
Primary
773
NM
Other
Enumeration date
09/01/2006
Last updated
10/16/2019
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