Provider Demographics
NPI:1417122862
Name:GURULE, AUDREY WELLS (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:WELLS
Last Name:GURULE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6500 JEFFERSON ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3489
Mailing Address - Country:US
Mailing Address - Phone:505-843-8758
Mailing Address - Fax:505-843-8759
Practice Address - Street 1:14101 FAIRVIEW DR STE 300
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2537
Practice Address - Country:US
Practice Address - Phone:952-892-2650
Practice Address - Fax:952-892-2654
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2020-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20030201502080P0214X, 208000000X
NMRS200805252080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics