Healthcare Provider Details

I. General information

NPI: 1669501276
Provider Name (Legal Business Name): CHRISTINE TRUBIC HUNTLEY APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 MARIE PARK DR NE
ALBUQUERQUE NM
87123-1718
US

IV. Provider business mailing address

813 MARIE PARK DR NE
ALBUQUERQUE NM
87123-1718
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-2861
  • Fax:
Mailing address:
  • Phone: 505-400-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR45856
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number09874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: