Individual
NANCY GAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 EARLY ST, SANTA FE, NM 87505-1607
(505) 955-0410
(505) 955-8577
Mailing address
102 N CORONADO AVE, ESPANOLA, NM 87532-2700
(505) 629-1813
(505) 753-6947
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35588519
—
NM
Enumeration date
11/18/2016
Last updated
11/18/2016
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