Provider Demographics
NPI:1821277757
Name:TRUJILLO, MICHELLE ANGELA (CFNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELA
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CASA MORENA CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-6501
Mailing Address - Country:US
Mailing Address - Phone:505-927-8040
Mailing Address - Fax:
Practice Address - Street 1:8300 CASA MORENA CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-6501
Practice Address - Country:US
Practice Address - Phone:505-927-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-27
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR48769163WG0000X
NMCNP01205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice