Individual
MS. JUDITH L. GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., C.N.P.
Contact information
Practice address
4100 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5901
(505) 462-8517
(505) 462-8510
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP00153
NM
363LA2200X
Adult Health Nurse Practitioner
R14939
NM
Other
Enumeration date
09/21/2006
Last updated
03/21/2018
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