Healthcare Provider Details

I. General information

NPI: 1558205633
Provider Name (Legal Business Name): GRACIELA YUDITH IBARRA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7223 LUNA AZUL AVE SW
ALBUQUERQUE NM
87121-9107
US

IV. Provider business mailing address

7223 LUNA AZUL AVE SW
ALBUQUERQUE NM
87121-9107
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-6896
  • Fax:
Mailing address:
  • Phone: 505-573-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number88858
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: