Individual
MAMIE DENETCLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
US HWY 491 NORTH, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
R26082
NM
163WD0400X
Diabetes Educator Registered Nurse
Primary
R26082
NM
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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