MEDICARE: MS. MICHELLE GALLEGOS C-PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	79165	NM
2	363LP0200X	Pediatric Nurse Practitioner	70791	NM

General Provider Information

NPI Number	:	1538742945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE GALLEGOS C-PNP

Provider Business Mailing Address
First Line	:	336 LUIS SANCHEZ PL SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87105-6359
Country	:	US
Telephone Number	:	505-927-2609
Fax Number	:

Provider Business Practice Location Address
First Line	:	8650 ALAMEDA BLVD NE STE 101
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-3791
Country	:	US
Telephone Number	:	505-255-1866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	06/23/2023

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