Individual
ANITRA CONNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 766-5197
Mailing address
1217 1ST ST NW, ALBUQUERQUE, NM 87102-1529
(505) 767-1101
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YIF915000683
—
NM
Enumeration date
08/09/2021
Last updated
09/14/2021
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