Provider Demographics
NPI:1679540942
Name:STAGNER, JEANNE GAIL (CNM, FNP-C, MSN)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:GAIL
Last Name:STAGNER
Suffix:
Gender:F
Credentials:CNM, FNP-C, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 DYER ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4803
Mailing Address - Country:US
Mailing Address - Phone:575-888-4067
Mailing Address - Fax:575-449-2425
Practice Address - Street 1:3225 DYER ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4803
Practice Address - Country:US
Practice Address - Phone:575-888-4067
Practice Address - Fax:575-888-4067
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM725367A00000X
NM59814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM47823071Medicaid
ORR176941OtherMEDICARE PTAN
NM567052YRNDOtherMEDICARE
NM13552716Medicaid
AZZ157796OtherMEDICARE PTAN
OR085311Medicaid
WA9625898Medicaid
NM89076044Medicaid