Healthcare Provider Details

I. General information

NPI: 1841711637
Provider Name (Legal Business Name): NOAH A BANKHURST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MONTGOMERY BLVD NE BLDG B, STE 100
ALBUQUERQUE NM
87109
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-924-5840
  • Fax: 505-924-5841
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number03272
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: