Healthcare Provider Details

I. General information

NPI: 1831614155
Provider Name (Legal Business Name): ERICA MARIE MARQUEZ NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA MARIE URBINA RN

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 E NIZHONI BLVD
GALLUP NM
87301-5748
US

IV. Provider business mailing address

501 STAGECOACH RD
GALLUP NM
87301-6738
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax:
Mailing address:
  • Phone: 505-409-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN-75049
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03230749
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number73389
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: