Individual
JACKIE E CONNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
502 ELM ST NE, ALBUQUERQUE, NM 87102-2512
(505) 841-1000
Mailing address
502 ELM ST NE, ALBUQUERQUE, NM 87102-2512
(505) 841-1000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CERTIFICATE ONLY
CO
Other
Enumeration date
06/12/2009
Last updated
03/02/2011
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