Provider Demographics
NPI:1578756672
Name:KURUVILLA, ANSU MARY (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:ANSU
Middle Name:MARY
Last Name:KURUVILLA
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1101 MEDICAL ARTS AVE NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2706
Practice Address - Country:US
Practice Address - Phone:505-272-1754
Practice Address - Fax:505-925-4594
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-02184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily