Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | CNP-02554 | NM |
NPI | 1013306166 |
---|---|
Provider Name | Anariza Grush |
First Address | Durango, CO 81303-6817 |
Second Address | Farmington, NM 87401-5638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2015 |
Last Update Date | 13/01/2015 |