Healthcare Provider Details

I. General information

NPI: 1467127845
Provider Name (Legal Business Name): KRISTA JOLENE GURULE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 09/27/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 KILMER AVE NW
ALBUQUERQUE NM
87120-1410
US

IV. Provider business mailing address

6016 KILMER AVE NW
ALBUQUERQUE NM
87120-1410
US

V. Phone/Fax

Practice location:
  • Phone: 505-681-5287
  • Fax:
Mailing address:
  • Phone: 505-681-5287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64739
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: