Individual
MELISSA CRILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
174 KRISTIE LN, TYRONE, GA 30290-2508
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN177878
GA
Other
Enumeration date
06/02/2020
Last updated
06/02/2020
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