Advanced Diabetes Care, LLC.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

ADVANCED DIABETES CARE, LLC.

Practice address

4425 Juan Tabo Blvd NE Ste 103B
Albuquerque, NM 87111-2684

Phone

(505) 881-4648

Fax

(505) 881-4694

NPI assigned

Nov 29, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julie D KrawchuckNPI 1003983800

Title

Owner/CFNP

Phone

(505) 881-4648

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Julie D Krawchuck, CFNP

  • Family Nurse Practitioner
  • Albuquerque, NM
  • NPI 1003983800

  NM

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658188800000",
    "number": "1366744229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 JUAN TABO BLVD NE STE 103B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112684",
            "telephone_number": "505-881-4648",
            "fax_number": "505-881-4694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 JUAN TABO BLVD NE STE 103B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871112684",
            "telephone_number": "505-881-4648",
            "fax_number": "505-881-4694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIABETES CARE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-29",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "KRAWCHUCK",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/CFNP",
        "authorized_official_telephone_number": "505-881-4648"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21682364",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Albuquerque, NM
• Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.