Individual
JACQUELINE ALISIA VIOLET BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
345 BASILEO DR, GALLUP, NM 87301-4655
(505) 721-1800
(505) 721-1899
Mailing address
345 BASILEO DR, GALLUP, NM 87301-4655
(505) 721-1800
(505) 721-1899
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
64532
NM
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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