Healthcare Provider Details

I. General information

NPI: 1114773595
Provider Name (Legal Business Name): KATHERINE ASHLEY WILLABY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 3RD ST NW
ALBUQUERQUE NM
87102-1480
US

IV. Provider business mailing address

PO BOX 25884
ALBUQUERQUE NM
87125-0884
US

V. Phone/Fax

Practice location:
  • Phone: 505-884-4464
  • Fax: 505-884-0054
Mailing address:
  • Phone: 479-640-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: