| Heavenly Health Fnp | |
|
308 East Hill Avenue Gallup NM 87301 | |
| (505) 722-6770 | |
| (505) 722-6799 |
| Full Name | Heavenly Health Fnp |
|---|---|
| Speciality | Family Medicine |
| Location | 308 East Hill Avenue, Gallup, New Mexico |
| Authorized Official Name and Position | Georges Duval (VICE PRESIDENT) |
| Authorized Official Contact | 5057226770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Heavenly Health Fnp 308 East Hill Avenue Gallup NM 87301 Ph: (505) 722-6770 | Heavenly Health Fnp 308 East Hill Avenue Gallup NM 87301 Ph: (505) 722-6770 |
| NPI Number | 1427118926 |
|---|---|
| Provider Enumeration Date | 12/12/2006 |
| Last Update Date | 11/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427118926 | NPI | - | NPPES |
| S9269 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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