Healthcare Provider Details

I. General information

NPI: 1821714635
Provider Name (Legal Business Name): MEGAN AMY GILMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNSER BLVD NW
ALBUQUERQUE NM
87121-1927
US

IV. Provider business mailing address

301 UNSER BLVD NW
ALBUQUERQUE NM
87121-1927
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-4126
  • Fax:
Mailing address:
  • Phone: 505-688-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70233
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: