MEDICARE: JULENE ELLEN MORTENSEN CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	70000	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	70000	OTHER	NM	NM BOARD OF NURSING CNP LICENSE #

General Provider Information

NPI Number	:	1730897406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULENE ELLEN MORTENSEN CPNP-PC

Provider Business Mailing Address
First Line	:	4333 PAN AMERICAN FWY NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-6833
Country	:	US
Telephone Number	:	505-266-3835
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 PAN AMERICAN FWY NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-6833
Country	:	US
Telephone Number	:	505-266-3835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2022
Last Update Date	:	04/14/2026

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