Healthcare Provider Details

I. General information

NPI: 1124434253
Provider Name (Legal Business Name): TARA ROCHELLE KOLBERG WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 JEFFERSON ST NE STE 350
ALBUQUERQUE NM
87109-4361
US

IV. Provider business mailing address

1718 MENAUL BLVD NW
ALBUQUERQUE NM
87107-1030
US

V. Phone/Fax

Practice location:
  • Phone: 505-847-4100
  • Fax:
Mailing address:
  • Phone: 505-249-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10163507
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number63727
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: