Healthcare Provider Details

I. General information

NPI: 1427453380
Provider Name (Legal Business Name): NATHAN ROSECRANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MSC09 5030 1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

855 SILVER AVE SW
ALBUQUERQUE NM
87102-3020
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4814
  • Fax: 505-272-0240
Mailing address:
  • Phone: 505-532-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2024-1072
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: