Healthcare Provider Details

I. General information

NPI: 1073754420
Provider Name (Legal Business Name): KRISTIN M ORESKOVICH RN, PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAN MATEO BLVD NE SUITE 902
ALBUQUERQUE NM
87108-1519
US

IV. Provider business mailing address

300 SAN MATEO BLVD NE SUITE 902
ALBUQUERQUE NM
87108-1519
US

V. Phone/Fax

Practice location:
  • Phone: 505-222-8677
  • Fax: 505-841-5885
Mailing address:
  • Phone: 505-222-8677
  • Fax: 505-841-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR51848
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR51848
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: