MEDICARE: AUTUMN LUJAN NP-C

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	163W00000X	Registered Nurse	RN-89674	NM
2	363LF0000X	Family Nurse Practitioner	64797	NM

General Provider Information

NPI Number	:	1740953686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUTUMN LUJAN NP-C

Provider Business Mailing Address
First Line	:	4201 MONTANO RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5743
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MONTANO RD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-5743
Country	:	US
Telephone Number	:	505-922-4997
Fax Number	:

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	10/02/2023

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Directions to “ AUTUMN LUJAN NP-C” Practice Location

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