Stephanie Rae Datema, RN
Registered Nurse, Emergency in Gallup, NM. Individual provider (NPI-1).
NPI number1013344779
StatusActive
Last updated in NPPESSep 26, 2013
Details
- NPI
- 1013344779
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Stephanie Rae Datema
- Credential
- RN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 26, 2013
- Last updated
- Sep 26, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 163WE0003X | Registered Nurse, Emergency | RN-76978 | NM | Yes |
Practice location
516 E Nizhoni BlvdGallup, NM 87301-5748
Phone 505-722-1000
Mailing address
Po Box 1337Gallup, NM 87305-1337
Phone 505-722-1165
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