Provider Demographics
NPI:1346879574
Name:ORGAN MOUNTAINS FAMILY & WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:ORGAN MOUNTAINS FAMILY & WOMEN'S HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:STAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM, FNP-C
Authorized Official - Phone:575-888-4067
Mailing Address - Street 1:3225 DYER ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4803
Mailing Address - Country:US
Mailing Address - Phone:575-888-4067
Mailing Address - Fax:575-888-4067
Practice Address - Street 1:3225 DYER ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4803
Practice Address - Country:US
Practice Address - Phone:575-888-4067
Practice Address - Fax:575-888-4067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty