Individual
KRYSTAL DAWN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
516 EAST NIZHONI BLVD, GALLUP, NM 87301
(505) 722-1000
Mailing address
19125 US HIGHWAY 18, BATESLAND, SD 57716-3072
(308) 360-3633
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12351314-9934
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2021
Last updated
08/05/2021
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