Provider Demographics
NPI:1770705154
Name:GIESSING GOURLEY, JULIE A (LM, LDEM)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:A
Last Name:GIESSING GOURLEY
Suffix:
Gender:F
Credentials:LM, LDEM
Other - Prefix:MS
Other - First Name:JULES
Other - Middle Name:
Other - Last Name:GIESSING GOURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM
Mailing Address - Street 1:2224 LAS BRISAS CT SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-796-6890
Mailing Address - Fax:
Practice Address - Street 1:2224 LAS BRISAS CT SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124
Practice Address - Country:US
Practice Address - Phone:505-796-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6221845-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife