Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | CNP02306 | NM |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | CNP02306 | NM |
NPI | 1124374004 |
---|---|
Provider Name | Julianne Austin |
First Address | Albuquerque, NM 87105-1630 |
Second Address | Albuquerque, NM 87105-1630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 19/08/2019 |