Healthcare Provider Details

I. General information

NPI: 1700798782
Provider Name (Legal Business Name): JULIANNE RENEE INGRAM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 ACADEMY RD NE STE B
ALBUQUERQUE NM
87109-3363
US

IV. Provider business mailing address

1620 N MAIN ST
SPANISH FORK UT
84660-1008
US

V. Phone/Fax

Practice location:
  • Phone: 505-514-0767
  • Fax: 866-913-0013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number92035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: