Healthcare Provider Details

I. General information

NPI: 1528535291
Provider Name (Legal Business Name): GENEVIEVE S LAURIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 5 PTS RD SW
ALBUQUERQUE NM
87105-3179
US

IV. Provider business mailing address

1528 5 PTS RD SW
ALBUQUERQUE NM
87105-3179
US

V. Phone/Fax

Practice location:
  • Phone: 505-717-2397
  • Fax:
Mailing address:
  • Phone: 505-717-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54350
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: