Healthcare Provider Details

I. General information

NPI: 1891290722
Provider Name (Legal Business Name): BONNIE KAUFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 COTTONWOOD CT NW
ALBUQUERQUE NM
87107-6633
US

IV. Provider business mailing address

221 COTTONWOOD CT NW
ALBUQUERQUE NM
87107-6633
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-7589
  • Fax: 505-345-0519
Mailing address:
  • Phone: 505-239-7589
  • Fax: 505-345-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR12427
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: