Basic Information
| Provider Information | |||||||||
| NPI: | 1689617466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARGESON | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1515 E 20TH ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874019039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053266400 | ||||||||
| FaxNumber: | 5053264606 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 W MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | NM | ||||||||
| PostalCode: | 874015630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053266400 | ||||||||
| FaxNumber: | 5053264606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/11/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R54519 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00442537 | 01 | NM | RR MEDICARE | OTHER | 106865 | 05 | AZ | MEDICAID | T0515 | 05 | UT | MEDICAID | 202008371 | 01 | NM | PRESBYTERIAN HP | OTHER | 14033399 | 05 | NM | MEDICAID | 35209372 | 05 | CO | MEDICAID | 10027982 | 01 | NM | LOVELACE HP | OTHER | NM006E21 | 01 | NM | BCBS | OTHER |