Provider Demographics
NPI:1730275710
Name:GORBUNOVA, SVETLANA A (NP)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:A
Last Name:GORBUNOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:201 CEDAR ST SE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4917
Mailing Address - Country:US
Mailing Address - Phone:505-563-2800
Mailing Address - Fax:505-563-2821
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:SUITE 800
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-563-2800
Practice Address - Fax:505-563-2821
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR58901363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36501387Medicaid
NM36501387Medicaid