Individual
ELLYCE CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
12 TWIN BUTTES DRIVE, ZUNI, NM 87327
(505) 782-5511
Mailing address
PO BOX A, ZUNI, NM 87327-0166
(505) 870-3624
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R15796
NM
163WS0200X
School Registered Nurse
230487
NM
Other
Enumeration date
11/15/2016
Last updated
11/15/2016
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