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Individual

GINA LYNN VAN AUSDALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CHW

Contact information

Practice address
400 GOLD AVE SW, ALBUQUERQUE, NM 87102-3283
(505) 224-9124
Mailing address
400 GOLD AVE SW, ALBUQUERQUE, NM 87102-3283
(505) 224-9124

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
G-1740
NM
175T00000X
Peer Specialist
Primary
G-1740
NM

Other

Enumeration date
03/27/2025
Last updated
02/24/2026
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