Healthcare Provider Details

I. General information

NPI: 1134388796
Provider Name (Legal Business Name): CARMEN MARIE HOLDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2008
Last Update Date: 06/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

4908 MARIAH RD NW
ALBUQUERQUE NM
87120-2453
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1090
  • Fax:
Mailing address:
  • Phone: 505-294-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR45607
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: