Individual
MRS. JAREN P GRAVAGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP, RNFA
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4397
(505) 842-8171
(505) 246-0684
Mailing address
610 BROADWAY BLVD NE, ALBUQUERQUE, NM 87102-2372
(505) 242-3991
(505) 242-3993
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R57758
NM
163WR0006X
Registered Nurse First Assistant
R57758
NM
363L00000X
Nurse Practitioner
Primary
CNP-02956
NM
363LF0000X
Family Nurse Practitioner
CNP-02956
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNP-02956
CERTIFIED NURSE PRACTIONER LICENSE
NM
01
—
R57758
RN LICENSE
NM
Enumeration date
01/19/2015
Last updated
05/26/2021
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