Individual
MICHAEL HENNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
110 SHEEP SPRINGS, JEMEZ PUEBLO, NM 87024-0279
(575) 834-7413
(575) 834-7517
Mailing address
PO BOX 279, JEMEZ PUEBLO, NM 87024-0279
(575) 834-7413
(575) 834-7517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
75-167
NM
Other
Enumeration date
03/24/2006
Last updated
09/25/2024
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