Provider Demographics
NPI:1255492559
Name:MCCOURT, GWENDOLYN FRANCILLE
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:FRANCILLE
Last Name:MCCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GWENDOLYN
Other - Middle Name:FRANCILLE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:843 SAN MIGUEL
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5360
Mailing Address - Country:US
Mailing Address - Phone:505-443-1929
Mailing Address - Fax:505-443-1929
Practice Address - Street 1:843 SAN MIGUEL
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5360
Practice Address - Country:US
Practice Address - Phone:505-443-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM163WG0000X163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice