Individual
MRS. MYRIAM ALLEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OTR.
Contact information
Practice address
1000 E.AZTEC AVE, GALLUP, NM 87301
(505) 721-1800
(505) 721-1899
Mailing address
937 E BUENA VISTA AVE, APARTMENT B, GALLUP, NM 87301-5510
(505) 721-1899
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1628
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000F1388
—
NM
Enumeration date
05/02/2006
Last updated
07/09/2007
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