Provider Demographics
NPI:1710199286
Name:CALHOUN, GLORIA JEAN (RN, MSN, CCM)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:JEAN
Last Name:CALHOUN
Suffix:
Gender:F
Credentials:RN, MSN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 PRINCETON DR, SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2875
Mailing Address - Country:US
Mailing Address - Phone:505-463-6876
Mailing Address - Fax:505-792-3715
Practice Address - Street 1:215 PRINCETON DR, SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2875
Practice Address - Country:US
Practice Address - Phone:505-463-6876
Practice Address - Fax:505-792-3715
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR30216163WA2000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator