Provider Demographics
NPI:1073221313
Name:HULTQUIST, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:HULTQUIST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:MARION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4609 TAYLOR RIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5716
Mailing Address - Country:US
Mailing Address - Phone:505-379-5037
Mailing Address - Fax:
Practice Address - Street 1:4824 MCMAHON BLVD NW STE 109
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5412
Practice Address - Country:US
Practice Address - Phone:505-379-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical