=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467758755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARLA G ENRIQUEZ ACNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 02/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1574 CAMINO RUSTICA SW
-----------------------------------------------------
City | LOS LUNAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87031-8114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-804-6934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 BRADBURY DR SE STE 116
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87106-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-272-1476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | CNP-01737
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------