Provider Demographics
NPI:1649991613
Name:LANDRUM, MARGARET AMY
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:AMY
Last Name:LANDRUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 COUNTY ROAD 141
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-7646
Mailing Address - Country:US
Mailing Address - Phone:850-602-0315
Mailing Address - Fax:
Practice Address - Street 1:4019 COUNTY ROAD 141
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-7646
Practice Address - Country:US
Practice Address - Phone:850-602-0315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0997976-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health