Healthcare Provider Details

I. General information

NPI: 1366744229
Provider Name (Legal Business Name): ADVANCED DIABETES CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GRINGO GULCH RD
PLACITAS NM
87043-8721
US

IV. Provider business mailing address

11024 MONTGOMERY BLVD NE # 253
ALBUQUERQUE NM
87111-3962
US

V. Phone/Fax

Practice location:
  • Phone: 505-881-4648
  • Fax: 505-881-4694
Mailing address:
  • Phone: 505-881-4648
  • Fax: 505-881-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JULIE D KRAWCHUCK
Title or Position: OWNER/CFNP
Credential:
Phone: 505-881-4648