Healthcare Provider Details

I. General information

NPI: 1679540942
Provider Name (Legal Business Name): JEANNE GAIL STAGNER CNM, FNP-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2006
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
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 TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number725
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number59814
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: