Healthcare Provider Details

I. General information

NPI: 1972018984
Provider Name (Legal Business Name): DEBORAH KOLKMEYER M.S, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DEBORAH HAGENGRUBER

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 AVENIDA CURVATURA NW
ALBUQUERQUE NM
87107-2635
US

IV. Provider business mailing address

3500 AVENIDA CURVATURA NW
ALBUQUERQUE NM
87107-2635
US

V. Phone/Fax

Practice location:
  • Phone: 505-345-1339
  • Fax:
Mailing address:
  • Phone: 505-345-1339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: