Individual
MS. MARY JANE GALLAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
622 W MAPLE, SUITE B, FARMINGTON, NM 87401
(505) 327-4867
(505) 327-5355
Mailing address
4901 LANG AVE NE, SUITE 100, ALBUQUERQUE, NM 87109-4495
(505) 883-2574
(505) 265-4033
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2003-0025
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56576
—
NM
05
—
89374878
—
NM
01
—
P00446751
RAILROAD MCRE PTAN
NM
Enumeration date
07/07/2005
Last updated
05/10/2016
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