Provider Demographics
NPI:1124374004
Name:AUSTIN, JULIANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 CENTRAL AVE NW
Mailing Address - Street 2:SUITE K2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1630
Mailing Address - Country:US
Mailing Address - Phone:505-503-7250
Mailing Address - Fax:505-554-2313
Practice Address - Street 1:4201 CENTRAL AVE NW
Practice Address - Street 2:SUITE K2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1630
Practice Address - Country:US
Practice Address - Phone:505-503-7250
Practice Address - Fax:505-554-2313
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02306207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine