Healthcare Provider Details

I. General information

NPI: 1013058353
Provider Name (Legal Business Name): JANA GUNNELL M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COLLEGE DR
GALLUP NM
87301-7010
US

IV. Provider business mailing address

1204 PINON LN
GALLUP NM
87301-5646
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-4572
  • Fax: 505-722-3134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number84-45
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: