LANCE R BURRELL

SAN FIDEL, NM
NPI1730146754
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: AZ  AP4694)
Additional Taxonomies363LF0000X Nurse Practitioner, Family
(Licence: UT  5653727-4405)
Enumeration Date2006-04-26
Last Update Date2014-09-02
Business Address
-- LANCE R BURRELL APRN
EXIT 102 11/2 MI. SOUTH I-40 ACOMA-CANONCITO-LAGUNA INDIAN
SAN FIDEL, NM 87049-0130
Phone number: 505-552-5300
Mailing Address
-- LANCE R BURRELL APRN
PO BOX 130
SAN FIDEL, NM 87049-0130
Phone number: 505-552-5300
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