Healthcare Provider Details

I. General information

NPI: 1386065365
Provider Name (Legal Business Name): GILLIAN NORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SAN MATEO BLVD NE
ALBUQUERQUE NM
87108-1434
US

IV. Provider business mailing address

2551 COORS BLVD NW
ALBUQUERQUE NM
87120-1213
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-9511
  • Fax: 505-268-4350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-74065
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-74065
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number66067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: