Healthcare Provider Details

I. General information

NPI: 1902066020
Provider Name (Legal Business Name): KATE VELLENGA MERIWETHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 EUBANK BLVD NE
ALBUQUERQUE NM
87112-2923
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2245
  • Fax: 505-272-1109
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-272-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD2012-0147
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2012-0147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: