Individual
KELLY SHANNON GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
455 SAINT MICHAELS DR, SANTA FE, NM 87505-7601
(505) 913-8719
(505) 995-4959
Mailing address
2740 GALISTEO RD APT R, SANTA FE, NM 87505-5858
(505) 913-8719
(505) 995-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R56697
NM
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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