Angelita C Boloz, RN

Individual provider Active NPI Registered Nurse · Gallup, NM

NPI 1851620587 · NPPES record last updated Dec 8, 2009

Key facts

NPI
1851620587
Entity type
Individual (NPI type 1)
Primary specialty
Registered Nurse 163W00000X
License
RN110756 (AZ)
Practice address
516 Nizhoni Blvd
Gallup, NM 87301-5748
Phone
(505) 722-1666
Fax
(505) 722-1487
NPI assigned
Dec 8, 2009
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN110756AZMDRegistered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN110756 AZ Yes

Addresses

Primary practice location

516 Nizhoni Blvd
Gallup, NM 87301-5748

Mailing address

516 Nizhoni Blvd
Gallup, NM 87301-5748
Phone (505) 722-1666

Other providers in Gallup, NM

All providers in Gallup, NM · Registered Nurse in New Mexico

Sources for this page

Verify at the official NPI Registry.