Healthcare Provider Details

I. General information

NPI: 1730099292
Provider Name (Legal Business Name): NOMAD ECLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 MORA RD SW
ALBUQUERQUE NM
87105-4652
US

IV. Provider business mailing address

1444 MORA RD SW
ALBUQUERQUE NM
87105-4652
US

V. Phone/Fax

Practice location:
  • Phone: 505-738-3371
  • Fax:
Mailing address:
  • Phone: 505-738-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GENEVIEVE KUJAWA
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 512-507-9386