Provider Demographics
NPI:1649720822
Name:CREELMAN, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CREELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAISIE
Other - Middle Name:
Other - Last Name:CREELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2704 MCEARL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3009
Mailing Address - Country:US
Mailing Address - Phone:505-280-1544
Mailing Address - Fax:
Practice Address - Street 1:343 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8712
Practice Address - Country:US
Practice Address - Phone:505-866-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3597171W00000X
NM377103171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor