Individual
LORETTA MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
317 BORTOT DR, GALLUP, NM 87301-4779
(505) 722-0023
(505) 722-6977
Mailing address
PO BOX 3175, GALLUP, NM 87305-3175
(505) 722-0023
(505) 722-6977
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
67975739
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67975739
—
NM
Enumeration date
07/30/2015
Last updated
07/30/2015
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