Basic Information
| Provider Information | |||||||||
| NPI: | 1417122862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GURULE | ||||||||
| FirstName: | AUDREY | ||||||||
| MiddleName: | WELLS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6500 JEFFERSON ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871093489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058438758 | ||||||||
| FaxNumber: | 5058438759 | ||||||||
| Practice Location | |||||||||
| Address1: | 14101 FAIRVIEW DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553372537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528922650 | ||||||||
| FaxNumber: | 9528922654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | 2003020150 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 2080S0012X | RS20080525 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | 208000000X | 2003020150 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.