Healthcare Provider Details

I. General information

NPI: 1770705154
Provider Name (Legal Business Name): JULIE A GIESSING GOURLEY LM, LDEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULES GIESSING GOURLEY LM

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 LAS BRISAS CT SE
RIO RANCHO NM
87124
US

IV. Provider business mailing address

2224 LAS BRISAS CT SE
RIO RANCHO NM
87124
US

V. Phone/Fax

Practice location:
  • Phone: 505-796-6890
  • Fax:
Mailing address:
  • Phone: 505-796-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number6221845-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: