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General NPI Number Information
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NPI Number | 1356049449
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Entity Type | Individual
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Provider Name | GWENDOLYN CHARLEE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 1400 BARBARA LOOP SE STE A
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City | RIO RANCHO
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State | NM
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Zip | 87124-1088
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Country | US
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Telephone | 505-414-6449
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Fax |
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Provider Business Mailing Address
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Address Line | 1809 CHISHOLM TRL NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-4095
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Country | US
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Telephone | 505-610-7303
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 72118
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License Number State | NM
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