Healthcare Provider Details

I. General information

NPI: 1629154562
Provider Name (Legal Business Name): MARGARET JEAN GILLEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 STONE LAKE ROAD
DULCE NM
87528
US

IV. Provider business mailing address

PO BOX 2296
PAGOSA SPRINGS CO
81147-2296
US

V. Phone/Fax

Practice location:
  • Phone: 505-759-3291
  • Fax:
Mailing address:
  • Phone: 505-759-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number88939
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: