Individual
SHANA LYNN SAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
PO BOX 353, CHURCH ROCK, NM 87311-0353
(505) 879-7165
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
R57365
NM
Other
Enumeration date
09/24/2018
Last updated
09/24/2018
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