Individual
SHANE PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301
(505) 722-1000
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.11341-NA
OH
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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