Healthcare Provider Details

I. General information

NPI: 1093540932
Provider Name (Legal Business Name): MATHEW BURRIEL FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 MAIN ST. SW
LOS LUNAS NM
87031
US

IV. Provider business mailing address

328 MAIN ST. SW
LOS LUNAS NM
87031-8974
US

V. Phone/Fax

Practice location:
  • Phone: 505-916-5448
  • Fax:
Mailing address:
  • Phone: 505-916-5446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-90557
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: