Individual
JENNIFER MICHELLE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1790
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2017-0721
NM
208000000X
Pediatrics Physician
MD2017-0721
NM
Other
Enumeration date
04/12/2013
Last updated
03/17/2018
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