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Individual

DR. NICOLE GRUNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106-4930
(505) 841-1234
Mailing address
1645 14TH AVE SE, RIO RANCHO, NM 87124-4138
(720) 217-1647

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
8284
NE
207R00000X
Internal Medicine Physician
Primary
MD2021-0270
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MD2021-0270
STATE LICENSE
NM
Enumeration date
06/18/2018
Last updated
08/15/2022
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