Provider Demographics
NPI:1316323215
Name:MURRAY, NICOLE (APRN, AG-CNS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:APRN, AG-CNS
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7452 STAGHORN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3020
Mailing Address - Country:US
Mailing Address - Phone:512-699-4078
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128606364S00000X
NMCNS-00266364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350922601Medicaid
TX350922601Medicaid
TX440207YR7HMedicare PIN