Healthcare Provider Details

I. General information

NPI: 1154530962
Provider Name (Legal Business Name): CHRISTINE N NATHE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 TUCKER AVE NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

4009 SILVERY MINNOW PL NW
ALBUQUERQUE NM
87120-4741
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-8147
  • Fax:
Mailing address:
  • Phone: 505-833-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1230
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: