Provider Demographics
NPI:1952404469
Name:GILLISPIE, LAURA ANN (CNM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:GILLISPIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0680
Mailing Address - Country:US
Mailing Address - Phone:575-538-6014
Mailing Address - Fax:575-538-6017
Practice Address - Street 1:1000 W COLLEGE AVE STE 147
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4112
Practice Address - Country:US
Practice Address - Phone:575-538-6014
Practice Address - Fax:575-538-6017
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR27942367A00000X
NM541367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM#541OtherNM DEPT. OF HEALTH
NM24992OtherAM. COLLEGE NURSE MIDWIVE