Individual
GARRETT VANDERWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1808 W AZTEC AVE, GALLUP, NM 87301-6780
(505) 722-1000
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
1645507
CO
Other
Enumeration date
11/03/2020
Last updated
11/03/2020
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