Healthcare Provider Details

I. General information

NPI: 1932513025
Provider Name (Legal Business Name): KAREN GRACE GULLETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST NINTH AVE SIERRA VISTA HOSPITAL
TRUTH OR CONSEQUENCES NM
87901
US

IV. Provider business mailing address

800 EAST NINTH AVE SIERRA VISTA HOSPITAL
TRUTH OR CONSEQUENCES NM
87901
US

V. Phone/Fax

Practice location:
  • Phone: 575-743-1205
  • Fax: 575-894-7659
Mailing address:
  • Phone: 575-743-1205
  • Fax: 575-894-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR37727
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: