Individual
MRS. JASMINE MALEY GONZAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
943 TETON AVE, SHELBY, MT 59474-1526
(408) 477-6523
Mailing address
943 TETON AVE, SHELBY, MT 59474-1526
(408) 477-6523
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
110403
WV
363LA2200X
Adult Health Nurse Practitioner
Primary
110403
WV
Other
Enumeration date
04/01/2018
Last updated
10/05/2021
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