Healthcare Provider Details

I. General information

NPI: 1184536203
Provider Name (Legal Business Name): OWEN WILSON-CATHERS CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 QUINCY ST NE
ALBUQUERQUE NM
87108-1257
US

IV. Provider business mailing address

146 QUINCY ST NE
ALBUQUERQUE NM
87108-1257
US

V. Phone/Fax

Practice location:
  • Phone: 505-550-1306
  • Fax:
Mailing address:
  • Phone: 505-550-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: