Individual
TINA SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2105 HASLER VALLEY ROAD, GALLUP, NM 87301-8730
(505) 413-3447
(505) 808-4929
Mailing address
PO BOX 3902, YATAHEY, NM 87375-3902
(505) 250-4702
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
1416
NM
Other
Enumeration date
03/02/2023
Last updated
03/02/2023
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