Healthcare Provider Details

I. General information

NPI: 1346879574
Provider Name (Legal Business Name): ORGAN MOUNTAINS FAMILY & WOMEN'S HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 DYER ST
LAS CRUCES NM
88011-4803
US

IV. Provider business mailing address

3225 DYER ST
LAS CRUCES NM
88011-4803
US

V. Phone/Fax

Practice location:
  • Phone: 575-888-4067
  • Fax: 575-888-4067
Mailing address:
  • Phone: 575-888-4067
  • Fax: 575-449-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: JEANNE GAIL STAGNER
Title or Position: OWNER, MEMBER
Credential: CNM, FNP-C
Phone: 575-888-4067