Provider Demographics
NPI:1376058099
Name:ARCHULETA, MICHAEL M (DNP, AGACNP-BC, APRN)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:ARCHULETA
Suffix:
Gender:M
Credentials:DNP, AGACNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4243
Mailing Address - Country:US
Mailing Address - Phone:505-426-0700
Mailing Address - Fax:
Practice Address - Street 1:611 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4243
Practice Address - Country:US
Practice Address - Phone:055-426-0700
Practice Address - Fax:505-426-0702
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03461363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty