MEDICARE: KRISTEN NATHARIUS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	53350	NM

General Provider Information

NPI Number	:	1265919310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN NATHARIUS NP

Provider Business Mailing Address
First Line	:	2227 VISTA DE COLINAS DR SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-2940
Country	:	US
Telephone Number	:	575-640-8128
Fax Number	:

Provider Business Practice Location Address
First Line	:	2227 VISTA DE COLINAS DR SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-2940
Country	:	US
Telephone Number	:	575-640-8128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2018
Last Update Date	:	07/22/2018

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