Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD2018-0691 | NM |
NPI | 1013335470 |
---|---|
Provider Name | Dr. Jennifer Coffey Gill |
First Address | Albuquerque, NM 87109 |
Second Address | Albuquerque, NM 87109-3460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14252585 | CAQH (01) | NM |