Individual
HALEY JAEY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1202 MAIN ST NE, LOS LUNAS, NM 87031-7409
(505) 565-0070
Mailing address
957 BENJAMIN DR SE, RIO RANCHO, NM 87124-1239
(580) 630-9500
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
55095
NM
Other
Enumeration date
12/11/2019
Last updated
12/11/2019
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