Individual
MR. DANNY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN
Contact information
Practice address
516 E. NIZHONI BLVD, GALLUP, NM 87301-1337
(505) 722-1000
Mailing address
PO BOX 1337, 516 E. NIZHONI BLVD, GALLUP, NM 87301-1337
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
641564
TX
Other
Enumeration date
03/14/2014
Last updated
03/14/2014
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