Provider Demographics
NPI:1003983800
Name:KRAWCHUCK, JULIE D (CFNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:KRAWCHUCK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 JUAN TABO BLVD NE STE 103B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2684
Mailing Address - Country:US
Mailing Address - Phone:505-881-4648
Mailing Address - Fax:505-881-4694
Practice Address - Street 1:4425 JUAN TABO BLVD NE STE 103B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2684
Practice Address - Country:US
Practice Address - Phone:505-881-4648
Practice Address - Fax:505-881-4694
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR37980363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ5744Medicaid
NMZ5744Medicaid